Provider Demographics
NPI:1508417916
Name:PASQUARIELLO, CASSANDRA D (PHD, MS, EDM)
Entity Type:Individual
Prefix:DR
First Name:CASSANDRA
Middle Name:D
Last Name:PASQUARIELLO
Suffix:
Gender:F
Credentials:PHD, MS, EDM
Other - Prefix:MRS
Other - First Name:CASSANDRA
Other - Middle Name:DEMETRIA
Other - Last Name:PASQUARIELLO WALLACE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:999 N PACIFIC ST UNIT B2
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92054-2081
Mailing Address - Country:US
Mailing Address - Phone:707-227-8511
Mailing Address - Fax:
Practice Address - Street 1:999 N PACIFIC ST UNIT B2
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92054-2081
Practice Address - Country:US
Practice Address - Phone:707-227-8511
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-26
Last Update Date:2022-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY26752103TC1900X
WI3669-57103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling