Provider Demographics
NPI:1538908454
Name:BASILE, JUSTINE (MED, NCC)
Entity type:Individual
Prefix:MRS
First Name:JUSTINE
Middle Name:
Last Name:BASILE
Suffix:
Gender:F
Credentials:MED, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:185 MORRIS ST
Mailing Address - Street 2:
Mailing Address - City:CLYMER
Mailing Address - State:PA
Mailing Address - Zip Code:15728-1264
Mailing Address - Country:US
Mailing Address - Phone:724-840-7749
Mailing Address - Fax:
Practice Address - Street 1:1105 SCALP AVE
Practice Address - Street 2:
Practice Address - City:JOHNSTOWN
Practice Address - State:PA
Practice Address - Zip Code:15904-3036
Practice Address - Country:US
Practice Address - Phone:833-668-6861
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-21
Last Update Date:2024-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health