Provider Demographics
NPI:1972512010
Name:PASQUALE, ANTOINETTE JOYCE (LPC)
Entity type:Individual
Prefix:
First Name:ANTOINETTE
Middle Name:JOYCE
Last Name:PASQUALE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:TONI
Other - Middle Name:J
Other - Last Name:PASQUALE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPC
Mailing Address - Street 1:3211 W 20TH ST STE D
Mailing Address - Street 2:
Mailing Address - City:GREELEY
Mailing Address - State:CO
Mailing Address - Zip Code:80634-6566
Mailing Address - Country:US
Mailing Address - Phone:970-356-3100
Mailing Address - Fax:970-356-4827
Practice Address - Street 1:3211 W 20TH ST STE D
Practice Address - Street 2:
Practice Address - City:GREELEY
Practice Address - State:CO
Practice Address - Zip Code:80634-6566
Practice Address - Country:US
Practice Address - Phone:970-356-3100
Practice Address - Fax:970-356-4827
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1238101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO463575OtherVALUE OPTIONS
CO643342OtherBLUE CROSS