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Individual

DR. DEIDRE BASSOLINO

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
PHD

Contact information

Practice address
760 BROADWAY, BROOKLYN, NY 11206-5317
(718) 963-5832
Mailing address
15 WILLIAM ST, NEW YORK, NY 10005-2886
(347) 463-6807

Taxonomy

Speciality
Code
Description
License number
State
103TC1900X
Counseling Psychologist
Primary
025399
NY
390200000X
Student in an Organized Health Care Education/Training Program

Other

Enumeration date
08/23/2019
Last updated
02/03/2023
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