Provider Demographics
NPI:1316388739
Name:BASSIN, ABBE LYNN (LCSW)
Entity Type:Individual
Prefix:MS
First Name:ABBE
Middle Name:LYNN
Last Name:BASSIN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:ABBE
Other - Middle Name:LYNN
Other - Last Name:BASSIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:16252 WINDFALL RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63005-4756
Mailing Address - Country:US
Mailing Address - Phone:917-297-1800
Mailing Address - Fax:
Practice Address - Street 1:15421 CLAYTON RD
Practice Address - Street 2:SUITE G-4
Practice Address - City:BALLWIN
Practice Address - State:MO
Practice Address - Zip Code:63011-3161
Practice Address - Country:US
Practice Address - Phone:917-297-1800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-14
Last Update Date:2014-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20120303181041C0700X
NY72191051041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical