Healthcare Provider Details

I. General information

NPI: 1831853308
Provider Name (Legal Business Name): AMANDA GRACE BASSETT I
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/29/2021
Last Update Date: 03/12/2025
Certification Date: 03/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31 HILLER RD
ROCHESTER MA
02770-4024
US

IV. Provider business mailing address

53 MARION RD UNIT 2
WAREHAM MA
02571-1406
US

V. Phone/Fax

Practice location:
  • Phone: 774-454-1994
  • Fax: 508-273-2353
Mailing address:
  • Phone: 774-454-1994
  • Fax: 508-273-2353

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License NumberSPA100478
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: