Provider Demographics
NPI:1457060709
Name:BASSIN, VERONIKA
Entity Type:Individual
Prefix:
First Name:VERONIKA
Middle Name:
Last Name:BASSIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3740 TAMIAMI TRL # 494334
Mailing Address - Street 2:
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33952-8317
Mailing Address - Country:US
Mailing Address - Phone:941-298-7045
Mailing Address - Fax:
Practice Address - Street 1:207 CROSS ST STE 202
Practice Address - Street 2:
Practice Address - City:PUNTA GORDA
Practice Address - State:FL
Practice Address - Zip Code:33950-4445
Practice Address - Country:US
Practice Address - Phone:941-298-7045
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-15
Last Update Date:2024-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical