Healthcare Provider Details

I. General information

NPI: 1477006732
Provider Name (Legal Business Name): ANTHONY M. DEPASQUALE LICENSE PSYCHOLOGIST
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2016
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

309 FELLOWSHIP RD STE 200
MOUNT LAUREL NJ
08054-1234
US

IV. Provider business mailing address

1817 MT. HOLLY RD STE C7 #109
BURLINGTON NJ
08016
US

V. Phone/Fax

Practice location:
  • Phone: 609-232-2894
  • Fax:
Mailing address:
  • Phone: 609-232-2894
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number35SI00768000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: