Provider Demographics
NPI:1407195332
Name:BASUALDO, MARIA
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:
Last Name:BASUALDO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MARIA
Other - Middle Name:
Other - Last Name:BASUALDO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMHC
Mailing Address - Street 1:14195 OLD SHERIDAN ST
Mailing Address - Street 2:
Mailing Address - City:SOUTHWEST RANCHES
Mailing Address - State:FL
Mailing Address - Zip Code:33330-3628
Mailing Address - Country:US
Mailing Address - Phone:305-494-7721
Mailing Address - Fax:
Practice Address - Street 1:14195 OLD SHERIDAN ST
Practice Address - Street 2:
Practice Address - City:SOUTHWEST RANCHES
Practice Address - State:FL
Practice Address - Zip Code:33330-3628
Practice Address - Country:US
Practice Address - Phone:305-494-7721
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-13
Last Update Date:2021-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH11010101Y00000X
101YA0400X, 101YM0800X
FL103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health