Healthcare Provider Details

I. General information

NPI: 1275586117
Provider Name (Legal Business Name): RONALD E. BASIL LCSW, MSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 02/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

590 S OCOTILLO AVE
BENSON AZ
85602-6405
US

IV. Provider business mailing address

489 N ARROYO BLVD
NOGALES AZ
85621-2644
US

V. Phone/Fax

Practice location:
  • Phone: 800-586-7080
  • Fax: 520-586-3163
Mailing address:
  • Phone: 520-287-4713
  • Fax: 520-287-9794

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW5070
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: