Provider Demographics
NPI:1376017673
Name:BASCO, BRITTANY VIOLETTE
Entity Type:Individual
Prefix:
First Name:BRITTANY
Middle Name:VIOLETTE
Last Name:BASCO
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:BRITTANY
Other - Middle Name:VIOLETTE
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:183 CEDAR RD
Mailing Address - Street 2:
Mailing Address - City:MICKLETON
Mailing Address - State:NJ
Mailing Address - Zip Code:08056-1014
Mailing Address - Country:US
Mailing Address - Phone:219-742-4087
Mailing Address - Fax:
Practice Address - Street 1:321 YALE AVE
Practice Address - Street 2:
Practice Address - City:STRATFORD
Practice Address - State:NJ
Practice Address - Zip Code:08084-1247
Practice Address - Country:US
Practice Address - Phone:888-859-7749
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-20
Last Update Date:2019-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ0-18-9271106E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst