Healthcare Provider Details

I. General information

NPI: 1467792630
Provider Name (Legal Business Name): BASAK EFE PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/25/2013
Last Update Date: 11/17/2025
Certification Date: 11/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

275 GROVE ST STE 2400
AUBURNDALE MA
02466-2273
US

IV. Provider business mailing address

20 GREEN LN
SHERBORN MA
01770-1311
US

V. Phone/Fax

Practice location:
  • Phone: 617-286-4486
  • Fax:
Mailing address:
  • Phone: 617-286-4486
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number10229
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: