Provider Demographics
NPI:1013425586
Name:BASSI MENTAL HEALTH PA
Entity Type:Organization
Organization Name:BASSI MENTAL HEALTH PA
Other - Org Name:TELEPSYCHHEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:DANIEL
Authorized Official - Last Name:BASSI
Authorized Official - Suffix:
Authorized Official - Credentials:MD MS
Authorized Official - Phone:888-730-5220
Mailing Address - Street 1:12058 SAN JOSE BLVD STE 202
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32223-8669
Mailing Address - Country:US
Mailing Address - Phone:888-730-5220
Mailing Address - Fax:888-524-8166
Practice Address - Street 1:12058 SAN JOSE BLVD STE 202
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32223-8669
Practice Address - Country:US
Practice Address - Phone:888-730-5220
Practice Address - Fax:888-524-8166
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-17
Last Update Date:2022-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME1295462084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty