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General NPI Number Information
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NPI Number | 1740979103
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Entity Type | Individual
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Provider Name | ANTHONY BASILOVECCHIO JR.
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Gender | Male
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Dates
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Enumeration Date | 05/02/2023
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Last Update Date | 11/09/2025
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Provider Practice Location Address
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Address Line | 580 S GODDARD BLVD
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City | KING OF PRUSSIA
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State | PA
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Zip | 19406-3270
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Country | US
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Telephone | 302-298-1153
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Fax |
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Provider Business Mailing Address
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Address Line | 580 S GODDARD BLVD APT 6130
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City | KING OF PRUSSIA
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State | PA
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Zip | 19406-3399
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Country | US
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Telephone |
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | PC016484
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License Number State | PA
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