Basic Information
| Provider Information | |||||||||
| NPI: | 1811471162 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DEPASQUALE | ||||||||
| FirstName: | SUZANNE | ||||||||
| MiddleName: | MELISSA | ||||||||
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| Credential: | M.ED MSW LSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 203 BURNING TREE BLVD | ||||||||
| Address2: | |||||||||
| City: | ABSECON | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 082012237 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9542263744 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 802 TILTON RD | ||||||||
| Address2: | |||||||||
| City: | NORTHFIELD | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 082251233 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6098227979 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/22/2018 | ||||||||
| LastUpdateDate: | 09/22/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | 44SL06337900 | NJ | Y | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.