Healthcare Provider Details

I. General information

NPI: 1174833909
Provider Name (Legal Business Name): JAMIE SU BASKETT MSW, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/14/2010
Last Update Date: 01/03/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1761 BROADWAY ST STE 100
VALLEJO CA
94589-2227
US

IV. Provider business mailing address

1761 BROADWAY ST STE 100
VALLEJO CA
94589-2227
US

V. Phone/Fax

Practice location:
  • Phone: 707-645-2700
  • Fax: 707-645-2181
Mailing address:
  • Phone: 707-645-2700
  • Fax: 707-645-2181

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: