Provider Demographics
NPI:1003388661
Name:BASSETT, SAMANTHA (CASAC, MHC-LP)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:
Last Name:BASSETT
Suffix:
Gender:F
Credentials:CASAC, MHC-LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:175 FULTON AVE STE 300
Mailing Address - Street 2:
Mailing Address - City:HEMPSTEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11550-3702
Mailing Address - Country:US
Mailing Address - Phone:516-481-0052
Mailing Address - Fax:516-481-2115
Practice Address - Street 1:175 FULTON AVE STE 300
Practice Address - Street 2:
Practice Address - City:HEMPSTEAD
Practice Address - State:NY
Practice Address - Zip Code:11550-3702
Practice Address - Country:US
Practice Address - Phone:516-481-0052
Practice Address - Fax:516-481-2115
Is Sole Proprietor?:No
Enumeration Date:2018-12-20
Last Update Date:2018-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY32700101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)