Provider Demographics
NPI:1821025727
Name:PASCALE, VICTOR P
Entity Type:Individual
Prefix:
First Name:VICTOR
Middle Name:P
Last Name:PASCALE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9744 WOOD PINE CT
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33467-2340
Mailing Address - Country:US
Mailing Address - Phone:561-967-3050
Mailing Address - Fax:561-968-2069
Practice Address - Street 1:9744 WOOD PINE CT
Practice Address - Street 2:
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33467-2340
Practice Address - Country:US
Practice Address - Phone:561-967-3050
Practice Address - Fax:561-968-2069
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY4710103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU1684Medicare ID - Type Unspecified