Provider Demographics
NPI:1619158110
Name:BRENT A. BASILE, MSW, LLC
Entity Type:Organization
Organization Name:BRENT A. BASILE, MSW, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL SOCIAL WORKER
Authorized Official - Prefix:MR
Authorized Official - First Name:BRENT
Authorized Official - Middle Name:ANTONY
Authorized Official - Last Name:BASILE
Authorized Official - Suffix:
Authorized Official - Credentials:LISW
Authorized Official - Phone:216-374-8382
Mailing Address - Street 1:20613 BEACONSFIELD BLVD
Mailing Address - Street 2:
Mailing Address - City:ROCKY RIVER
Mailing Address - State:OH
Mailing Address - Zip Code:44116-1307
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:20800 CENTER RIDGE RD
Practice Address - Street 2:SUITE 324
Practice Address - City:ROCKY RIVER
Practice Address - State:OH
Practice Address - Zip Code:44116-4312
Practice Address - Country:US
Practice Address - Phone:216-374-8382
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-26
Last Update Date:2007-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.07000261041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty