MEDICARE: MS. JACLYN MARIE PASQUARELLI LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	44SC05353300	NJ

General Provider Information

NPI Number	:	1396985453
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JACLYN MARIE PASQUARELLI LCSW

Provider Business Mailing Address
First Line	:	786 MOUNTAIN BLVD
Second Line	:	SUITE 104
City	:	WATCHUNG
State	:	NJ
Zip	:	07069-6268
Country	:	US
Telephone Number	:	908-322-9623
Fax Number	:	908-322-8703

Provider Business Practice Location Address
First Line	:	786 MOUNTAIN BLVD
Second Line	:	SUITE 104
City	:	WATCHUNG
State	:	NJ
Zip	:	07069-6268
Country	:	US
Telephone Number	:	908-322-9623
Fax Number	:	908-322-8703

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/03/2009
Last Update Date	:	08/07/2013

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