Provider Demographics
NPI:1821207887
Name:PASQUARELLI, JOHN RICHARD (LCSW)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:RICHARD
Last Name:PASQUARELLI
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1004
Mailing Address - Street 2:175 BENN HILL ROAD
Mailing Address - City:HOULTON
Mailing Address - State:ME
Mailing Address - Zip Code:04730-1004
Mailing Address - Country:US
Mailing Address - Phone:207-521-0497
Mailing Address - Fax:
Practice Address - Street 1:2 WATER ST
Practice Address - Street 2:SUITE 2
Practice Address - City:HOULTON
Practice Address - State:ME
Practice Address - Zip Code:04730-2126
Practice Address - Country:US
Practice Address - Phone:207-532-5510
Practice Address - Fax:207-532-5518
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC68361041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical