Healthcare Provider Details

I. General information

NPI: 1184770042
Provider Name (Legal Business Name): GAIL S BASS MSW. LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/25/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

53 EAGLE ST
PITTSFIELD MA
01201-4714
US

IV. Provider business mailing address

PO BOX 187
HOUSATONIC MA
01236-0187
US

V. Phone/Fax

Practice location:
  • Phone: 413-236-5656
  • Fax: 413-499-6572
Mailing address:
  • Phone: 413-274-6955
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number113167
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: