Provider Demographics
NPI:1821150525
Name:PASQUELLA, MARY (PHD)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:
Last Name:PASQUELLA
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12661 HEMING LN
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20716-1118
Mailing Address - Country:US
Mailing Address - Phone:301-262-5758
Mailing Address - Fax:301-352-3939
Practice Address - Street 1:12661 HEMING LN
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20716-1118
Practice Address - Country:US
Practice Address - Phone:301-262-5758
Practice Address - Fax:301-352-3939
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-16
Last Update Date:2011-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD02354103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD595039Medicare ID - Type Unspecified