Individual
JACQUELINE MARIE BASILE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
4200 MONUMENT RD, PHILADELPHIA, PA 19131-1625
(215) 581-3748
(215) 581-3781
Mailing address
4200 MONUMENT RD, PHILADELPHIA, PA 19131-1625
(215) 581-3748
(215) 581-3781
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
CW016836
PA
Other
Enumeration date
09/01/2016
Last updated
09/01/2016
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