Provider Demographics
NPI:1093465387
Name:BASILE, SANTINO (MS)
Entity Type:Individual
Prefix:
First Name:SANTINO
Middle Name:
Last Name:BASILE
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3160 POWERLINE RD
Mailing Address - Street 2:
Mailing Address - City:OAKLAND PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33309-5911
Mailing Address - Country:US
Mailing Address - Phone:954-567-7141
Mailing Address - Fax:
Practice Address - Street 1:3160 POWERLINE RD
Practice Address - Street 2:
Practice Address - City:OAKLAND PARK
Practice Address - State:FL
Practice Address - Zip Code:33309-5911
Practice Address - Country:US
Practice Address - Phone:954-567-7141
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-28
Last Update Date:2022-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMH22119101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health