Provider Demographics
NPI:1578281085
Name:BASSANELLO, ALESSANDRA B
Entity Type:Individual
Prefix:
First Name:ALESSANDRA
Middle Name:B
Last Name:BASSANELLO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1515 PARTRIDGE AVE
Mailing Address - Street 2:
Mailing Address - City:SUNNYVALE
Mailing Address - State:CA
Mailing Address - Zip Code:94087-4952
Mailing Address - Country:US
Mailing Address - Phone:831-383-8638
Mailing Address - Fax:
Practice Address - Street 1:1515 PARTRIDGE AVE
Practice Address - Street 2:
Practice Address - City:SUNNYVALE
Practice Address - State:CA
Practice Address - Zip Code:94087-4952
Practice Address - Country:US
Practice Address - Phone:831-383-8638
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-19
Last Update Date:2022-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA77092104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1649337338OtherAPPROVED EAP INSURANCES