Provider Demographics
NPI:1780151456
Name:BASMAJIAN, PATRICIA JEANNE (LCSW-R)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:JEANNE
Last Name:BASMAJIAN
Suffix:
Gender:F
Credentials:LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4102 VESTAL RD
Mailing Address - Street 2:
Mailing Address - City:VESTAL
Mailing Address - State:NY
Mailing Address - Zip Code:13850-3531
Mailing Address - Country:US
Mailing Address - Phone:607-772-1598
Mailing Address - Fax:607-584-7679
Practice Address - Street 1:4102 VESTAL RD
Practice Address - Street 2:
Practice Address - City:VESTAL
Practice Address - State:NY
Practice Address - Zip Code:13850-3531
Practice Address - Country:US
Practice Address - Phone:607-772-1598
Practice Address - Fax:607-584-7679
Is Sole Proprietor?:No
Enumeration Date:2018-10-31
Last Update Date:2018-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0441036-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical