Provider Demographics
NPI:1417262627
Name:BASKIN, MICHELLE MARIE NAMETH (MED, BCBA, COBA)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:MARIE NAMETH
Last Name:BASKIN
Suffix:
Gender:F
Credentials:MED, BCBA, COBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6537 BRECKSVILLE RD
Mailing Address - Street 2:
Mailing Address - City:INDEPENDENCE
Mailing Address - State:OH
Mailing Address - Zip Code:44131-4855
Mailing Address - Country:US
Mailing Address - Phone:216-503-1234
Mailing Address - Fax:216-503-1233
Practice Address - Street 1:6537 BRECKSVILLE RD
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:OH
Practice Address - Zip Code:44131-4855
Practice Address - Country:US
Practice Address - Phone:216-503-1234
Practice Address - Fax:216-503-1233
Is Sole Proprietor?:No
Enumeration Date:2010-08-11
Last Update Date:2022-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1096416103K00000X
OH1096020103K00000X
OH110103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst