Provider Demographics
NPI:1932800604
Name:BASSIN, DARA L (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:DARA
Middle Name:L
Last Name:BASSIN
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4452 37TH ST APT 5
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92116-4663
Mailing Address - Country:US
Mailing Address - Phone:917-830-3284
Mailing Address - Fax:
Practice Address - Street 1:4452 37TH ST APT 5
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92116-4663
Practice Address - Country:US
Practice Address - Phone:917-830-3284
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-10
Last Update Date:2023-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP31597235Z00000X
NJ41YS01030500235Z00000X
NJO1-0012153235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist