Provider Demographics
NPI:1144464124
Name:PASQUA MARONGIU PSY D PA
Entity type:Organization
Organization Name:PASQUA MARONGIU PSY D PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:PASQUA
Authorized Official - Middle Name:MARIA
Authorized Official - Last Name:MARONGIU
Authorized Official - Suffix:
Authorized Official - Credentials:PSY D
Authorized Official - Phone:321-431-3222
Mailing Address - Street 1:1970 MICHIGAN AVE
Mailing Address - Street 2:BUILDING C-1
Mailing Address - City:COCOA
Mailing Address - State:FL
Mailing Address - Zip Code:32922-5758
Mailing Address - Country:US
Mailing Address - Phone:321-639-0063
Mailing Address - Fax:321-639-0064
Practice Address - Street 1:1970 MICHIGAN AVE
Practice Address - Street 2:BUILDING C-1
Practice Address - City:COCOA
Practice Address - State:FL
Practice Address - Zip Code:32922-5758
Practice Address - Country:US
Practice Address - Phone:321-639-0063
Practice Address - Fax:321-639-0064
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-22
Last Update Date:2010-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY7776261QM0855X, 261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health