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General NPI Number Information
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NPI Number | 1205307931
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Entity Type | Individual
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Provider Name | MARLA K PASQUA
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Gender | Female
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Dates
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Enumeration Date | 12/06/2018
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Last Update Date | 12/18/2018
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Provider Practice Location Address
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Address Line | 850 WATERMAN AVE
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City | EAST PROVIDENCE
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State | RI
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Zip | 02914-1729
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Country | US
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Telephone | 401-434-0459
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Fax |
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Provider Business Mailing Address
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Address Line | 51 ROMA ST
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City | EAST PROVIDENCE
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State | RI
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Zip | 02914-2516
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Country | US
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Telephone | 401-749-2528
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | CDP00618
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License Number State | RI
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