Individual
MR. KENNETH VINCENT BASCOM JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MA
Contact information
Practice address
1855 FAIR AVE, HONESDALE, PA 18431-2121
(570) 253-3980
(570) 253-3982
Mailing address
151 WARNER RD, NORTH BRANCH, NY 12766-5045
(845) 482-5080
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
647010
PA
Other
Enumeration date
08/13/2019
Last updated
08/13/2019
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