Provider Demographics
NPI:1578108502
Name:BASKIN, JOEL PETER (LPC)
Entity Type:Individual
Prefix:
First Name:JOEL
Middle Name:PETER
Last Name:BASKIN
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:180 HICKORY LN
Mailing Address - Street 2:
Mailing Address - City:CLOSTER
Mailing Address - State:NJ
Mailing Address - Zip Code:07624-2301
Mailing Address - Country:US
Mailing Address - Phone:201-280-4973
Mailing Address - Fax:
Practice Address - Street 1:10 MINELL PL
Practice Address - Street 2:
Practice Address - City:TEANECK
Practice Address - State:NJ
Practice Address - Zip Code:07666-5508
Practice Address - Country:US
Practice Address - Phone:201-280-4973
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-13
Last Update Date:2019-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJPC00919101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJPC00919OtherSTATE OF NEW JERSEY