Provider Demographics
NPI:1457413676
Name:BASSILIOS, JOSEPHINE A (LSW)
Entity Type:Individual
Prefix:MRS
First Name:JOSEPHINE
Middle Name:A
Last Name:BASSILIOS
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 HAYESWOLD DR
Mailing Address - Street 2:
Mailing Address - City:CORAOPOLIS
Mailing Address - State:PA
Mailing Address - Zip Code:15108-3162
Mailing Address - Country:US
Mailing Address - Phone:412-262-5173
Mailing Address - Fax:
Practice Address - Street 1:6324 MARCHAND ST
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15206-4312
Practice Address - Country:US
Practice Address - Phone:412-661-1239
Practice Address - Fax:412-661-1304
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW012328L104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0005525880001Medicaid