Provider Demographics
NPI:1770457822
Name:BASU, NATASHA (PHD)
Entity type:Individual
Prefix:DR
First Name:NATASHA
Middle Name:
Last Name:BASU
Suffix:
Gender:X
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:850 ELM GROVE RD STE 17
Mailing Address - Street 2:
Mailing Address - City:ELM GROVE
Mailing Address - State:WI
Mailing Address - Zip Code:53122-2527
Mailing Address - Country:US
Mailing Address - Phone:414-909-0110
Mailing Address - Fax:
Practice Address - Street 1:850 ELM GROVE RD STE 17
Practice Address - Street 2:
Practice Address - City:ELM GROVE
Practice Address - State:WI
Practice Address - Zip Code:53122-2527
Practice Address - Country:US
Practice Address - Phone:414-909-0110
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-10-01
Last Update Date:2025-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI544357103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist