MEDICARE: LAUREN K BASSO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1225223688
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAUREN K BASSO

Provider Business Mailing Address
First Line	:	4660 1ST ST
Second Line	:
City	:	VERO BEACH
State	:	FL
Zip	:	32968-2364
Country	:	US
Telephone Number	:	772-778-4471
Fax Number	:

Provider Business Practice Location Address
First Line	:	4660 1ST ST
Second Line	:
City	:	VERO BEACH
State	:	FL
Zip	:	32968-2364
Country	:	US
Telephone Number	:	772-778-4471
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/10/2007
Last Update Date	:	09/10/2007

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