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General NPI Number Information
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NPI Number | 1518198076
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Entity Type | Individual
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Provider Name | KELLY LYNN BASSETT LP, M.ED
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Gender | Male
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Dates
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Enumeration Date | 07/31/2009
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Last Update Date | 11/17/2015
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Provider Practice Location Address
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Address Line | 1 SHEPPARD RD SUITE 704
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City | VOORHEES
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State | NJ
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Zip | 08043-4608
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Country | US
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Telephone | 646-510-1593
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Fax |
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Provider Business Mailing Address
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Address Line | 1 SHEPPARD RD SUITE 704
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City | VOORHEES
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State | NJ
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Zip | 08043-4608
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Country | US
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Telephone | 646-510-1593
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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 | 102L00000X
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Taxonomy Name | Psychoanalyst
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License Number | 000913
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License Number State | NY
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