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General NPI Number Information
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NPI Number | 1013425586
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Entity Type | Organization
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Legal Business Name | BASSI MENTAL HEALTH PA
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Dates
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Enumeration Date | 01/17/2018
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Last Update Date | 06/04/2024
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Provider Practice Location Address
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Address Line | 1820 STATE ROAD 13 N STE 11-926
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City | ST JOHNS
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State | FL
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Zip | 32259-8856
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Country | US
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Telephone | 888-730-5220
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Fax | 888-524-8166
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Provider Business Mailing Address
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Address Line | 12058 SAN JOSE BLVD STE 202
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City | JACKSONVILLE
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State | FL
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Zip | 32223-8669
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Country | US
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Telephone | 888-730-5220
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Fax | 888-524-8166
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. BRUCE DANIEL BASSI
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Credential | MD MS
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Telephone | 888-730-5220
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | ME129546
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License Number State | FL
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