Provider Demographics
NPI:1467596874
Name:BASS, BOBBY (BOBBY BASS, LCSW)
Entity Type:Individual
Prefix:MS
First Name:BOBBY
Middle Name:
Last Name:BASS
Suffix:
Gender:F
Credentials:BOBBY BASS, LCSW
Other - Prefix:MS
Other - First Name:BARBARA
Other - Middle Name:
Other - Last Name:BASS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:8 HILLSIDE AVE
Mailing Address - Street 2:SUITE 206
Mailing Address - City:MONTCLAIR
Mailing Address - State:NJ
Mailing Address - Zip Code:07042-2129
Mailing Address - Country:US
Mailing Address - Phone:973-819-3377
Mailing Address - Fax:
Practice Address - Street 1:8 HILLSIDE AVE
Practice Address - Street 2:SUITE 206
Practice Address - City:MONTCLAIR
Practice Address - State:NJ
Practice Address - Zip Code:07042-2129
Practice Address - Country:US
Practice Address - Phone:973-819-3377
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-18
Last Update Date:2016-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC04564300174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJSC45643OtherNJ BOARD OF SOCIAL WORK
NJP3457598OtherOXFORD HEALTH PLAN OUT OF NETWORK PROVIDER
NJ492298000OtherMAGELLAN BEHAVIORAL HEALTH OUT OF NETWORK PROVIDER