Provider Demographics
NPI:1467142620
Name:SOMBIE, BASSIE
Entity Type:Individual
Prefix:MR
First Name:BASSIE
Middle Name:
Last Name:SOMBIE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8723 W CHESTER PIKE APT D6
Mailing Address - Street 2:
Mailing Address - City:UPPER DARBY
Mailing Address - State:PA
Mailing Address - Zip Code:19082-1113
Mailing Address - Country:US
Mailing Address - Phone:610-396-7119
Mailing Address - Fax:
Practice Address - Street 1:1653 LITITZ PIKE
Practice Address - Street 2:STE 2130
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17601-6507
Practice Address - Country:US
Practice Address - Phone:302-990-2323
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-11
Last Update Date:2023-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PABH006194103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst