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General NPI Number Information
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NPI Number | 1184664351
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Entity Type | Individual
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Provider Name | ANGEL RAFAEL BASABE LICENSED CLINICAL SO
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Gender | Male
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Dates
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Enumeration Date | 06/07/2006
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Last Update Date | 07/20/2022
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Provider Practice Location Address
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Address Line | 313 N PLANKINTON AVE STE 207
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City | MILWAUKEE
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State | WI
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Zip | 53203-3104
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Country | US
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Telephone | 414-677-0155
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Fax | 414-677-0153
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Provider Business Mailing Address
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Address Line | PO BOX 320683
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City | FRANKLIN
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State | WI
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Zip | 53132-6111
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Country | US
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Telephone | 414-677-0155
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Fax | 414-677-0153
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 2323123
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License Number State | WI
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