Provider Demographics
NPI:1083988331
Name:BASILE, AMY BETH (LMHC)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:BETH
Last Name:BASILE
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:687 HIGHLAND AVE
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:NEEDHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02494-2232
Mailing Address - Country:US
Mailing Address - Phone:781-559-8444
Mailing Address - Fax:
Practice Address - Street 1:687 HIGHLAND AVE
Practice Address - Street 2:2ND FLOOR
Practice Address - City:NEEDHAM
Practice Address - State:MA
Practice Address - Zip Code:02494-2232
Practice Address - Country:US
Practice Address - Phone:781-559-8444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-05
Last Update Date:2012-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA7079101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health