Healthcare Provider Details

I. General information

NPI: 1710054895
Provider Name (Legal Business Name): JOANNE ROSE PASQUERELLO PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/30/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1938 ROUTE 6
CARMEL NY
10512-2311
US

IV. Provider business mailing address

16 LAKEVIEW TER
AMAWALK NY
10501-1202
US

V. Phone/Fax

Practice location:
  • Phone: 845-225-5650
  • Fax:
Mailing address:
  • Phone: 914-245-4381
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number0120251
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: