Provider Demographics
NPI:1952650004
Name:BASS, AMI P (LCSW)
Entity Type:Individual
Prefix:
First Name:AMI
Middle Name:P
Last Name:BASS
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 1:10 WATER STREET
Mailing Address - Street 2:SUITE 303
Mailing Address - City:WATERVILLE
Mailing Address - State:ME
Mailing Address - Zip Code:04901-6566
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10 WATER ST
Practice Address - Street 2:SUITE 303
Practice Address - City:WATERVILLE
Practice Address - State:ME
Practice Address - Zip Code:04901-6566
Practice Address - Country:US
Practice Address - Phone:207-861-3500
Practice Address - Fax:207-861-6201
Is Sole Proprietor?:No
Enumeration Date:2012-09-05
Last Update Date:2014-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC149301041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical