Provider Demographics
NPI:1124011192
Name:BASSETT, CHERYL LAFAVE (MSW)
Entity Type:Individual
Prefix:MRS
First Name:CHERYL
Middle Name:LAFAVE
Last Name:BASSETT
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3333 SPRING ARBOR RD
Mailing Address - Street 2:STE 800
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49203-8605
Mailing Address - Country:US
Mailing Address - Phone:517-782-2442
Mailing Address - Fax:517-782-0310
Practice Address - Street 1:3333 SPRING ARBOR RD
Practice Address - Street 2:STE 800
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49203-8605
Practice Address - Country:US
Practice Address - Phone:517-782-2442
Practice Address - Fax:517-782-0310
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010199941041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
0M38330Medicare ID - Type Unspecified