Healthcare Provider Details

I. General information

NPI: 1255709713
Provider Name (Legal Business Name): DANIEL KEISER DEPASQUALE M.S.W.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2015
Last Update Date: 09/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5130 E MAIN STREET RD SUITE 2
BATAVIA NY
14020-3444
US

IV. Provider business mailing address

5130 E MAIN STREET RD SUITE 2
BATAVIA NY
14020-3444
US

V. Phone/Fax

Practice location:
  • Phone: 585-344-1421
  • Fax:
Mailing address:
  • Phone: 585-344-1421
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number104100000X
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: