Provider Demographics
NPI:1407395429
Name:BASDEN, DALENE
Entity Type:Individual
Prefix:
First Name:DALENE
Middle Name:
Last Name:BASDEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:177 FAYETTE ST
Mailing Address - Street 2:
Mailing Address - City:LYNN
Mailing Address - State:MA
Mailing Address - Zip Code:01902-2237
Mailing Address - Country:US
Mailing Address - Phone:781-775-0708
Mailing Address - Fax:781-599-9288
Practice Address - Street 1:177 FAYETTE ST
Practice Address - Street 2:
Practice Address - City:LYNN
Practice Address - State:MA
Practice Address - Zip Code:01902-2237
Practice Address - Country:US
Practice Address - Phone:781-775-0708
Practice Address - Fax:781-599-9288
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-23
Last Update Date:2017-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor