Healthcare Provider Details

I. General information

NPI: 1952073199
Provider Name (Legal Business Name): BASAL THERAPIES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2021
Last Update Date: 10/07/2021
Certification Date: 10/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8411 BROADBAND DR STE D
FREDERICK MD
21701-4741
US

IV. Provider business mailing address

5104 PEGASUS CT STE B
FREDERICK MD
21704-8323
US

V. Phone/Fax

Practice location:
  • Phone: 443-776-0271
  • Fax: 301-663-8322
Mailing address:
  • Phone: 443-776-0271
  • Fax: 301-663-8322

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: KATHRYN FERRO
Title or Position: DIRECTOR
Credential: SLP
Phone: 240-838-4346