Provider Demographics
NPI:1972649135
Name:DE BLASI, PASQUALE JR (LCSW)
Entity Type:Individual
Prefix:DR
First Name:PASQUALE
Middle Name:
Last Name:DE BLASI
Suffix:JR
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 1:175 W 79TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10024-6450
Mailing Address - Country:US
Mailing Address - Phone:212-595-0735
Mailing Address - Fax:
Practice Address - Street 1:175 W 79TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10024-6450
Practice Address - Country:US
Practice Address - Phone:212-595-0735
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0140721041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYR014072OtherLCSW
NYR014072OtherLCSW