Provider Demographics
NPI:1063554087
Name:PASQUALE, GINA M (PSYD)
Entity type:Individual
Prefix:DR
First Name:GINA
Middle Name:M
Last Name:PASQUALE
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 FEDERAL ST
Mailing Address - Street 2:
Mailing Address - City:KEENE
Mailing Address - State:NH
Mailing Address - Zip Code:03431-3632
Mailing Address - Country:US
Mailing Address - Phone:603-355-2244
Mailing Address - Fax:603-924-2240
Practice Address - Street 1:19 FEDERAL ST
Practice Address - Street 2:
Practice Address - City:KEENE
Practice Address - State:NH
Practice Address - Zip Code:03431-3632
Practice Address - Country:US
Practice Address - Phone:603-355-2244
Practice Address - Fax:603-924-2240
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2010-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH1190103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical