Provider Demographics
NPI:1316180078
Name:BASSI, BRIAN T (MA , MFT INTERN,)
Entity Type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:T
Last Name:BASSI
Suffix:
Gender:M
Credentials:MA , MFT INTERN,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:619 S BROADWAY APT B
Mailing Address - Street 2:
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90277-4202
Mailing Address - Country:US
Mailing Address - Phone:310-733-9679
Mailing Address - Fax:
Practice Address - Street 1:619 S BROADWAY APT B
Practice Address - Street 2:
Practice Address - City:REDONDO BEACH
Practice Address - State:CA
Practice Address - Zip Code:90277-4202
Practice Address - Country:US
Practice Address - Phone:310-733-9679
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-10
Last Update Date:2012-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA72461106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist