Healthcare Provider Details

I. General information

NPI: 1043522733
Provider Name (Legal Business Name): MARIA PASQUALETTI PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2010
Last Update Date: 02/06/2020
Certification Date: 02/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2222 WESTERN TRAILS BLVD STE 202
AUSTIN TX
78745-1647
US

IV. Provider business mailing address

2222 WESTERN TRAILS BLVD STE 202
AUSTIN TX
78745-1647
US

V. Phone/Fax

Practice location:
  • Phone: 512-448-3221
  • Fax: 512-448-3218
Mailing address:
  • Phone: 512-448-3221
  • Fax: 512-448-3218

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TF0200X
TaxonomyForensic Psychologist
License Number3-6773
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number3-6773
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: