Provider Demographics
NPI:1992855449
Name:BASKFIELD, VALENE RAYMER (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:VALENE
Middle Name:RAYMER
Last Name:BASKFIELD
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:PO BOX 401
Mailing Address - Street 2:
Mailing Address - City:RIDGWAY
Mailing Address - State:CO
Mailing Address - Zip Code:81432-0401
Mailing Address - Country:US
Mailing Address - Phone:970-318-0201
Mailing Address - Fax:
Practice Address - Street 1:543 S 2ND ST
Practice Address - Street 2:
Practice Address - City:MONTROSE
Practice Address - State:CO
Practice Address - Zip Code:81401-4244
Practice Address - Country:US
Practice Address - Phone:970-778-0490
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-10
Last Update Date:2013-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO9928881041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO11664605OtherCAQH
COCOB5205Medicare PIN