Healthcare Provider Details

I. General information

NPI: 1760314074
Provider Name (Legal Business Name): NICOLE ANN BASSETT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2026
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29 EMERSON AVE
GLOUCESTER MA
01930-2556
US

IV. Provider business mailing address

205 HIGHLAND AVE UNIT 3105
SALEM MA
01970-2757
US

V. Phone/Fax

Practice location:
  • Phone: 877-803-5564
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: