Provider Demographics
NPI:1174047419
Name:BASSO, ANGELA ANNETTE (MS, LMHC)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:ANNETTE
Last Name:BASSO
Suffix:
Gender:F
Credentials:MS, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6322 PALMA DEL MAR BLVD S APT 106
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33715-1250
Mailing Address - Country:US
Mailing Address - Phone:623-810-8252
Mailing Address - Fax:
Practice Address - Street 1:4300 DUHME RD
Practice Address - Street 2:
Practice Address - City:MADEIRA BEACH
Practice Address - State:FL
Practice Address - Zip Code:33708-2892
Practice Address - Country:US
Practice Address - Phone:727-391-7001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-28
Last Update Date:2017-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health