Provider Demographics
NPI:1831853308
Name:BASSETT, AMANDA GRACE I
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:GRACE
Last Name:BASSETT
Suffix:I
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:53 MARION RD UNIT 2
Mailing Address - Street 2:
Mailing Address - City:WAREHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02571-1406
Mailing Address - Country:US
Mailing Address - Phone:774-454-1994
Mailing Address - Fax:508-273-2353
Practice Address - Street 1:31 HILLER RD
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MA
Practice Address - Zip Code:02770-4024
Practice Address - Country:US
Practice Address - Phone:774-454-1994
Practice Address - Fax:508-273-2353
Is Sole Proprietor?:No
Enumeration Date:2021-10-29
Last Update Date:2025-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
MASPA1004782355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician