Basic Information
| Provider Information | |||||||||
| NPI: | 1255709713 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DEPASQUALE | ||||||||
| FirstName: | DANIEL | ||||||||
| MiddleName: | KEISER | ||||||||
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| Credential: | M.S.W. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5130 E MAIN STREET RD | ||||||||
| Address2: | SUITE 2 | ||||||||
| City: | BATAVIA | ||||||||
| State: | NY | ||||||||
| PostalCode: | 140203444 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5853441421 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 5130 E MAIN STREET RD | ||||||||
| Address2: | SUITE 2 | ||||||||
| City: | BATAVIA | ||||||||
| State: | NY | ||||||||
| PostalCode: | 140203444 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5853441421 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/14/2015 | ||||||||
| LastUpdateDate: | 09/14/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 104100000X | NY | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
ID Information
| ID | Type | State | Issuer | Description | P99350 | 01 | NY | LICENSED MASTER SOCIAL WORK - LIMITED PERMIT | OTHER |