Provider Demographics
NPI:1770896995
Name:BASCETTA, MICHELLE GAGE (MSW, LCSW)
Entity type:Individual
Prefix:MISS
First Name:MICHELLE
Middle Name:GAGE
Last Name:BASCETTA
Suffix:
Gender:
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:280 MADISON AVE RM 305E
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-0816
Mailing Address - Country:US
Mailing Address - Phone:929-320-0716
Mailing Address - Fax:929-298-7404
Practice Address - Street 1:280 MADISON AVE RM 305E
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-0816
Practice Address - Country:US
Practice Address - Phone:929-320-0716
Practice Address - Fax:929-298-7404
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-16
Last Update Date:2025-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0089921041C0700X
NY0804911041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty