Provider Demographics
NPI:1609968197
Name:DEPASQUALE, ANITA M (MA, LMHC)
Entity Type:Individual
Prefix:
First Name:ANITA
Middle Name:M
Last Name:DEPASQUALE
Suffix:
Gender:F
Credentials:MA, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6431 WALMORE RD
Mailing Address - Street 2:
Mailing Address - City:NIAGARA FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:14304-1641
Mailing Address - Country:US
Mailing Address - Phone:716-930-4767
Mailing Address - Fax:
Practice Address - Street 1:6431 WALMORE RD
Practice Address - Street 2:
Practice Address - City:NIAGARA FALLS
Practice Address - State:NY
Practice Address - Zip Code:14304-1641
Practice Address - Country:US
Practice Address - Phone:716-930-4767
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-29
Last Update Date:2012-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY000506354002OtherCOMMUNITY BLUE
NY00030241501OtherUNIVERA