MEDICARE: DR. HELENE BASS-WICHELHAUS PHD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	R011815	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P3192823	OTHER	NY	OXFORD

General Provider Information

NPI Number	:	1316067374
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HELENE BASS-WICHELHAUS PHD

Provider Business Mailing Address
First Line	:	108 EAST 86 STREET
Second Line	:	1SW
City	:	NEW YORK
State	:	NY
Zip	:	10028-1024
Country	:	US
Telephone Number	:	212-996-0050
Fax Number	:

Provider Business Practice Location Address
First Line	:	108 E 86TH ST
Second Line	:	1SW
City	:	NEW YORK
State	:	NY
Zip	:	10028-1024
Country	:	US
Telephone Number	:	212-996-0050
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/30/2007
Last Update Date	:	07/08/2007

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