Provider Demographics
NPI:1598202061
Name:BASEL, ANDREA COOK (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:ANDREA
Middle Name:COOK
Last Name:BASEL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:119 HIGHWOODS DR
Mailing Address - Street 2:
Mailing Address - City:GUILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06437-1942
Mailing Address - Country:US
Mailing Address - Phone:203-815-5288
Mailing Address - Fax:
Practice Address - Street 1:303 CHURCH ST UNIT B
Practice Address - Street 2:
Practice Address - City:GUILFORD
Practice Address - State:CT
Practice Address - Zip Code:06437-2468
Practice Address - Country:US
Practice Address - Phone:203-815-5288
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-23
Last Update Date:2022-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0095451041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical