Healthcare Provider Details

I. General information

NPI: 1316231913
Provider Name (Legal Business Name): SHAYNA S BASSETT PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SHAYNA H SOENKSEN M.S.

II. Dates (important events)

Enumeration Date: 06/01/2011
Last Update Date: 05/03/2021
Certification Date: 05/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 FRUIT ST
BOSTON MA
02114-2696
US

IV. Provider business mailing address

55 FRUIT ST
BOSTON MA
02114-2696
US

V. Phone/Fax

Practice location:
  • Phone: 617-724-2480
  • Fax:
Mailing address:
  • Phone: 617-724-2480
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License NumberPS01757
License Number StateRI
# 4
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPS01757
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: