Russoniello, Pasquale John
Russoniello, Pasquale John is an sole proprietor health care provider with primary practice located at 366 Fairfax Rd , Drexel Hill PA 19026-1007. He recently has 2 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Clinical, Behavioral Health & Social Service Providers / Psychologist. Behavioral Health & Social Service Providers / Psychologist is his primary health care specialty. Russoniello, Pasquale John can be contacted via phone (610) 316-6944.Contact Information
Primary practice address
366 Fairfax Rd
Drexel Hill PA 19026-1007
Phone: (610) 316-6944
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Behavioral Health & Social Service Providers / Clinical | 103TC0700X | PS002904L | Pennsylvania |
| Behavioral Health & Social Service Providers / Psychologist | 103T00000X | PS002904-L | Pennsylvania |
Profile Details
| NPI number | 1275740029 |
|---|---|
| LBN Legal business name | Russoniello, Pasquale John |
| Credentials | Master of Arts (MA) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | May 17th, 2007 |
| Last updated | Oct 1st, 2021 - about 4 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1275740029 | NPPES |
| Pennsylvania | Other | 11706713 | CAQH |
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