Deidre Bassolino, PHD

Primary specialty

Counseling PsychologistTaxonomy code 103TC1900X

License

025399 Issued in NY

Practice address

760 Broadway
Brooklyn, NY 11206-5317

Phone

(718) 963-5832

NPI assigned

Aug 23, 2019

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in NY

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1566518400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1675382400000",
    "number": "1083261077",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15 WILLIAM ST",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100052886",
            "telephone_number": "347-463-6807"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "760 BROADWAY",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112065317",
            "telephone_number": "718-963-5832"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BASSOLINO",
        "first_name": "DEIDRE",
        "name_prefix": "Dr.",
        "credential": "PHD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-08-23",
        "last_updated": "2023-02-03",
        "certification_date": "2023-02-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103TC1900X",
            "taxonomy_group": "",
            "desc": "Psychologist, Counseling",
            "state": "NY",
            "license": "025399",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sue Beth Bassetti, MA, LCSW
• Christine Joy Bassig-Santos, MD
• Samir Shafik Bassily, MD
• Samantha Elizabeth Bassler, PHD
• Brian S Bassner, MS ED
• Albert Bassoul, MD FAAP
• Myra Bassoul
• Nissim Bassoul, MD
• Jeffrey J Basti, MD
• Stacy Bastien-Renelique, M.S. CCC-SLP

• Counseling Psychologist in Brooklyn, NY
• Providers in Brooklyn, NY by specialty
• Counseling Psychologist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 3, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.