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General NPI Number Information
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NPI Number | 1013217546
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Entity Type | Individual
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Provider Name | DANIEL BASLOCK MSW
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Gender | Male
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Dates
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Enumeration Date | 11/01/2010
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Last Update Date | 03/17/2018
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Provider Practice Location Address
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Address Line | 190 EASTERN AVE
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City | ST JOHNSBURY
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State | VT
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Zip | 05819-5606
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Country | US
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Telephone | 802-535-9114
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Fax |
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Provider Business Mailing Address
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Address Line | 25 HILLTOP AVE
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City | BARRE
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State | VT
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Zip | 05641-4327
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Country | US
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Telephone | 802-535-9114
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 151.0126712
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License Number State | VT
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 089.0090488
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License Number State | VT
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