Provider Demographics
NPI:1326252032
Name:DIPASQUALE, MADELINE CAROL (PHD)
Entity Type:Individual
Prefix:DR
First Name:MADELINE
Middle Name:CAROL
Last Name:DIPASQUALE
Suffix:
Gender:F
Credentials:PHD
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 WEST TABOR ROAD
Mailing Address - Street 2:MOSSREHAB - DRUCKER BRAIN INJURY CENTER
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19104
Mailing Address - Country:US
Mailing Address - Phone:215-456-9544
Mailing Address - Fax:215-456-9579
Practice Address - Street 1:1200 W TABOR RD
Practice Address - Street 2:MOSSREHAB HOSPITAL-DRUCKER BRAIN INJURY CENTER
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19141-3019
Practice Address - Country:US
Practice Address - Phone:215-456-9544
Practice Address - Fax:215-456-9579
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-10
Last Update Date:2008-08-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAPS008333L103G00000X, 103T00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAP37931Medicare UPIN
PA050191Medicare ID - Type Unspecified