Provider Demographics
NPI:1356062350
Name:BASKIN, MARC D (LCSW, PHD)
Entity type:Individual
Prefix:DR
First Name:MARC
Middle Name:D
Last Name:BASKIN
Suffix:
Gender:M
Credentials:LCSW, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 WESTWARD HO
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23188-7474
Mailing Address - Country:US
Mailing Address - Phone:703-901-6933
Mailing Address - Fax:
Practice Address - Street 1:115 WESTWARD HO
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23188-7474
Practice Address - Country:US
Practice Address - Phone:703-901-6933
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-07
Last Update Date:2022-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040033721041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical