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Individual
THOMAS JOHN BASOLO
Active
Individual
THOMAS JOHN BASOLO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LAC
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
BBH-LAC-LIC-64524
MT
1041C0700X
Clinical Social Worker
Primary
BBH-SWLC-LIC-71592
MT
Other
Enumeration date
09/19/2023
Last updated
01/21/2026
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