Provider Demographics
NPI:1841023223
Name:BASKIN, THERESA (DSW)
Entity type:Individual
Prefix:DR
First Name:THERESA
Middle Name:
Last Name:BASKIN
Suffix:
Gender:F
Credentials:DSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:85 HEMINGWAY AVE APT A65
Mailing Address - Street 2:
Mailing Address - City:EAST HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06512-3470
Mailing Address - Country:US
Mailing Address - Phone:203-605-1277
Mailing Address - Fax:
Practice Address - Street 1:85 HEMINGWAY AVE APT A65
Practice Address - Street 2:
Practice Address - City:EAST HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06512-3470
Practice Address - Country:US
Practice Address - Phone:203-605-1277
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-22
Last Update Date:2024-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTMSW.000174104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty