Provider Demographics
NPI:1932761202
Name:DEPASQUALE, TESSA LYNN (MA, LPC)
Entity Type:Individual
Prefix:MRS
First Name:TESSA
Middle Name:LYNN
Last Name:DEPASQUALE
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 MEADOW HILLS DR
Mailing Address - Street 2:
Mailing Address - City:GUILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06437-1252
Mailing Address - Country:US
Mailing Address - Phone:401-413-5952
Mailing Address - Fax:
Practice Address - Street 1:476 POMFRET RD
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:CT
Practice Address - Zip Code:06234-1526
Practice Address - Country:US
Practice Address - Phone:860-774-5619
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-08
Last Update Date:2019-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001924101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional