Provider Demographics
NPI:1043522733
Name:PASQUALETTI, MARIA (PSYD)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:
Last Name:PASQUALETTI
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 1:2222 WESTERN TRAILS BLVD STE 202
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78745-1647
Mailing Address - Country:US
Mailing Address - Phone:512-448-3221
Mailing Address - Fax:512-448-3218
Practice Address - Street 1:2222 WESTERN TRAILS BLVD STE 202
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78745-1647
Practice Address - Country:US
Practice Address - Phone:512-448-3221
Practice Address - Fax:512-448-3218
Is Sole Proprietor?:No
Enumeration Date:2010-07-09
Last Update Date:2020-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3-6773103TF0200X, 103TC0700X
103TF0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic