Provider Demographics
NPI:1912094327
Name:BASSILI, LUCINDA JANE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:LUCINDA
Middle Name:JANE
Last Name:BASSILI
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1713 RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75006-3901
Mailing Address - Country:US
Mailing Address - Phone:469-546-5360
Mailing Address - Fax:469-375-2482
Practice Address - Street 1:1713 RIDGE RD
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75006-3901
Practice Address - Country:US
Practice Address - Phone:469-546-5360
Practice Address - Fax:469-375-2482
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-06
Last Update Date:2012-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX196711041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX188190769OtherGROUP PTAN: TXB139015
TX1912094327OtherINDIVIDUAL PTAN: TXB139016