Provider Demographics
NPI:1558436576
Name:PASCO, JACQUELINE VILLACORTA (MD)
Entity Type:Individual
Prefix:DR
First Name:JACQUELINE
Middle Name:VILLACORTA
Last Name:PASCO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:JACQUELINE
Other - Middle Name:FERN
Other - Last Name:VILLACORTA PASCO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:427 GUY PARK AVENUE
Mailing Address - Street 2:ST MARYS HEALTHCARE- BEHAVIORAL HEALTH
Mailing Address - City:AMSTERDAM
Mailing Address - State:NY
Mailing Address - Zip Code:12010
Mailing Address - Country:US
Mailing Address - Phone:518-841-7360
Mailing Address - Fax:518-841-7344
Practice Address - Street 1:427 GUY PARK AVE.
Practice Address - Street 2:ST MARYS HEALTHCARE- BEHAVIORAL HEALTH
Practice Address - City:AMSTERDAM
Practice Address - State:NY
Practice Address - Zip Code:12010
Practice Address - Country:US
Practice Address - Phone:518-841-7360
Practice Address - Fax:518-841-7344
Is Sole Proprietor?:No
Enumeration Date:2006-11-22
Last Update Date:2013-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2308082084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02519482Medicaid
NY02519482Medicaid
G88941Medicare UPIN