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General NPI Number Information
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NPI Number | 1770872889
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Entity Type | Individual
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Provider Name | JAN BASS LCSW
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Gender | Female
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Dates
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Enumeration Date | 03/30/2011
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Last Update Date | 06/15/2012
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Provider Practice Location Address
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Address Line | 1500 N JAMES ST
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City | ROME
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State | NY
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Zip | 13440-2844
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Country | US
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Telephone | 315-338-7570
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Fax | 315-338-7632
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Provider Business Mailing Address
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Address Line | 197 MAIN RD
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City | HERKIMER
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State | NY
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Zip | 13350-3405
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Country | US
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Telephone | 315-866-1174
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Fax | 315-866-1174
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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 | R055589
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License Number State | NY
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