Individual
REBECCA BASANTA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
355 CAPTAINS ROW, MERRITT ISLAND, FL 32952-5808
(714) 310-4223
Mailing address
355 CAPTAINS ROW, MERRITT ISLAND, FL 32952-5808
(714) 310-4223
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
—
—
222Q00000X
Developmental Therapist
Primary
—
—
Other
Enumeration date
09/13/2012
Last updated
09/23/2022
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