Basic Information
| Provider Information | |||||||||
| NPI: | 1457413676 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BASSILIOS | ||||||||
| FirstName: | JOSEPHINE | ||||||||
| MiddleName: | A | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | LSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 102 HAYESWOLD DR | ||||||||
| Address2: | |||||||||
| City: | CORAOPOLIS | ||||||||
| State: | PA | ||||||||
| PostalCode: | 151083162 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4122625173 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 6324 MARCHAND ST | ||||||||
| Address2: | |||||||||
| City: | PITTSBURGH | ||||||||
| State: | PA | ||||||||
| PostalCode: | 152064312 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4126611239 | ||||||||
| FaxNumber: | 4126611304 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/14/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | SW012328L | PA | Y | Behavioral Health & Social Service Providers | Social Worker |
ID Information
| ID | Type | State | Issuer | Description | 0005525880001 | 05 | PA | MEDICAID |