Provider Demographics
NPI:1083165997
Name:BASIL, ROBERT ALFRED (MSW)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:ALFRED
Last Name:BASIL
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:488 NE 18TH ST UNIT 4101
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33132-1327
Mailing Address - Country:US
Mailing Address - Phone:845-891-1704
Mailing Address - Fax:
Practice Address - Street 1:488 NE 18TH ST UNIT 4101
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33132-1327
Practice Address - Country:US
Practice Address - Phone:845-891-1704
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-17
Last Update Date:2023-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW199491041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYFK14913AMedicaid