Shante Antoinette Bassett, PSYD
Individual provider Active NPI Clinical Psychologist · Shelton, CT
NPI 1053183293 · NPPES record last updated Oct 23, 2023
Key facts
- NPI
- 1053183293
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Psychologist 103TC0700X
- License
- 4640 (CT)
- Practice address
- 3 Armstrong Rd # 1102
Shelton, CT 06484-4706 - Phone
- (516) 500-3119
- NPI assigned
- Oct 23, 2023
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CT
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20240206003536 | CT | Practitioner - Clinical Psychologist | 6901259209 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 026025 | NY | MD | Clinical Psychologist |
| 4640 | CT | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Rapha Mind & Body, LLC | Current |
Accepting new patients |
Locations
3 Armstrong Rd
Shelton, CT 06484
Phone (203) 913-4061
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 026025 | NY | |
| Clinical Psychologist | 103TC0700X | 4640 | CT | Yes |
Addresses
Primary practice location
3 Armstrong Rd # 1102
Shelton, CT 06484-4706
Mailing address
22 Happy Hollow Cir Unit B
Stratford, CT 06614-8411
Phone (917) 975-1822
Other providers in Shelton, CT
- Dorothy Ann Barr-Reseska
- Alexis Barran
- Jenna Barrett
- Theresa M Barrett
- Jacquelyn Basile
- Adrian V. Basu
- Harim Batacan
- Nami Bayan
- Alexandra L Becker
- Michael Bell
All providers in Shelton, CT · Clinical Psychologist in Connecticut
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 23, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.