Provider Demographics
NPI:1568960243
Name:PASCUAL, MARINO JR (BCBA)
Entity Type:Individual
Prefix:
First Name:MARINO
Middle Name:
Last Name:PASCUAL
Suffix:JR
Gender:M
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8179 MIDTOWN BLVD APT 6105
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231-4597
Mailing Address - Country:US
Mailing Address - Phone:559-269-5342
Mailing Address - Fax:
Practice Address - Street 1:5510 ABRAMS RD STE 112
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75214-2000
Practice Address - Country:US
Practice Address - Phone:469-906-6372
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-26
Last Update Date:2021-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-20-44475103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst