Provider Demographics
NPI:1417225368
Name:BASS, LAURIE (MSS LSW)
Entity Type:Individual
Prefix:MS
First Name:LAURIE
Middle Name:
Last Name:BASS
Suffix:
Gender:F
Credentials:MSS LSW
Other - Prefix:MS
Other - First Name:LAURIE
Other - Middle Name:
Other - Last Name:BENOWITZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSS LSW
Mailing Address - Street 1:1055 SILVER OAK PL
Mailing Address - Street 2:
Mailing Address - City:AMBLER
Mailing Address - State:PA
Mailing Address - Zip Code:19002-1627
Mailing Address - Country:US
Mailing Address - Phone:215-260-1555
Mailing Address - Fax:
Practice Address - Street 1:1062 E LANCASTER AVE
Practice Address - Street 2:SUITE 16
Practice Address - City:BRYN MAWR
Practice Address - State:PA
Practice Address - Zip Code:19010-1552
Practice Address - Country:US
Practice Address - Phone:215-260-1555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-07
Last Update Date:2013-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW123400104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker