Provider Demographics
NPI:1811146087
Name:BASAL, KATHRINE (LMSW)
Entity type:Individual
Prefix:
First Name:KATHRINE
Middle Name:
Last Name:BASAL
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:KATHRINE
Other - Middle Name:
Other - Last Name:OKEEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW
Mailing Address - Street 1:950 NORTON ST
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14621-3732
Mailing Address - Country:US
Mailing Address - Phone:585-324-3726
Mailing Address - Fax:
Practice Address - Street 1:950 NORTON ST
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14621-3732
Practice Address - Country:US
Practice Address - Phone:585-324-3726
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-12
Last Update Date:2009-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY074963104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00357502Medicaid