Healthcare Provider Details

I. General information

NPI: 1649905829
Provider Name (Legal Business Name): JENNIFER L. BASSETT LMFT, MCAP, CMHP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/20/2022
Last Update Date: 11/11/2023
Certification Date: 11/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

813 SIGSBEE ROAD PMB NO. 48
KEY WEST FL
33040
US

IV. Provider business mailing address

813 SIGSBEE ROAD PMB NO. 48
KEY WEST FL
33040-6700
US

V. Phone/Fax

Practice location:
  • Phone: 305-741-5065
  • Fax:
Mailing address:
  • Phone: 305-741-5065
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License NumberCBHCMS.0100649
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMT4770
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberMCAP100355
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberCMHP.0100014
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: