Provider Demographics
NPI:1164652780
Name:BASS, LINDA (MA)
Entity Type:Individual
Prefix:MS
First Name:LINDA
Middle Name:
Last Name:BASS
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 ESPLANADE WAY
Mailing Address - Street 2:
Mailing Address - City:BAYVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08721-1911
Mailing Address - Country:US
Mailing Address - Phone:732-281-9147
Mailing Address - Fax:
Practice Address - Street 1:17 ESPLANADE WAY
Practice Address - Street 2:
Practice Address - City:BAYVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08721-1911
Practice Address - Country:US
Practice Address - Phone:732-281-9147
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-16
Last Update Date:2009-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ001024533OtherMENTAL HEALTH COUNSELOR