Healthcare Provider Details

I. General information

NPI: 1275819716
Provider Name (Legal Business Name): JAMES ANTHONY BASILIO MS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/28/2011
Last Update Date: 10/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

313 S 16TH ASTREET
PHILADELPHIA PA
19102-4908
US

IV. Provider business mailing address

1441 MICHIGAN AVE
SWARTHMORE PA
19081-2718
US

V. Phone/Fax

Practice location:
  • Phone: 215-732-8244
  • Fax: 215-732-8454
Mailing address:
  • Phone: 484-431-8689
  • Fax: 215-732-8454

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPC006075
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: