Provider Demographics
NPI:1629257050
Name:BASSUK, RAQUEL TAMAR (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:RAQUEL
Middle Name:TAMAR
Last Name:BASSUK
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 1:90 KELLEYS TRL
Mailing Address - Street 2:
Mailing Address - City:OLDSMAR
Mailing Address - State:FL
Mailing Address - Zip Code:34677-1976
Mailing Address - Country:US
Mailing Address - Phone:727-772-0606
Mailing Address - Fax:
Practice Address - Street 1:90 KELLEYS TRL
Practice Address - Street 2:
Practice Address - City:OLDSMAR
Practice Address - State:FL
Practice Address - Zip Code:34677-1976
Practice Address - Country:US
Practice Address - Phone:727-772-0606
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-01
Last Update Date:2007-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW 8082174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist