Healthcare Provider Details

I. General information

NPI: 1760118947
Provider Name (Legal Business Name): MICHAEL PASCALE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/28/2022
Last Update Date: 11/15/2024
Certification Date: 11/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 OLD DERBY ST
HINGHAM MA
02043-4005
US

IV. Provider business mailing address

485 HUNTINGTON RD STE 199-202
ATHENS GA
30606-1861
US

V. Phone/Fax

Practice location:
  • Phone: 781-837-8833
  • Fax:
Mailing address:
  • Phone: 908-432-6652
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberRN2326935
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberRN2326935
License Number StateMA
# 3
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberRN328697
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: