Provider Demographics
NPI:1760760383
Name:BASSO, LINDSAY BROOKE (MA)
Entity Type:Individual
Prefix:MRS
First Name:LINDSAY
Middle Name:BROOKE
Last Name:BASSO
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:LINDSAY
Other - Middle Name:BROOKE
Other - Last Name:SHAPIRO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:6 PAWNEE DR
Mailing Address - Street 2:
Mailing Address - City:COMMACK
Mailing Address - State:NY
Mailing Address - Zip Code:11725-4211
Mailing Address - Country:US
Mailing Address - Phone:631-543-2390
Mailing Address - Fax:
Practice Address - Street 1:6 PAWNEE DR
Practice Address - Street 2:
Practice Address - City:COMMACK
Practice Address - State:NY
Practice Address - Zip Code:11725-4211
Practice Address - Country:US
Practice Address - Phone:631-543-2390
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-31
Last Update Date:2011-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017528-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist