Provider Demographics
NPI:1477811586
Name:DEPASCUAL, IVONNE (MA LPC)
Entity Type:Individual
Prefix:MRS
First Name:IVONNE
Middle Name:
Last Name:DEPASCUAL
Suffix:
Gender:F
Credentials:MA LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:452 KINGSLAND ST
Mailing Address - Street 2:
Mailing Address - City:NUTLEY
Mailing Address - State:NJ
Mailing Address - Zip Code:07110-1014
Mailing Address - Country:US
Mailing Address - Phone:201-259-1868
Mailing Address - Fax:973-235-1527
Practice Address - Street 1:452 KINGSLAND ST
Practice Address - Street 2:
Practice Address - City:NUTLEY
Practice Address - State:NJ
Practice Address - Zip Code:07110-1014
Practice Address - Country:US
Practice Address - Phone:201-259-1868
Practice Address - Fax:973-235-1527
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-26
Last Update Date:2012-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00444500101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional