Susannah Coburn Bastek, LICSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

113728 Issued in MA

Practice address

129 King St
Northampton, MA 01060-3258

Phone

(413) 586-0390

NPI assigned

Jan 18, 2007

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Servicenet Inc

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Northampton, MA
  • NPI 1659314425
  NPD (past)

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

{
    "created_epoch": "1169078400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1841343613",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "185 N MAPLE ST",
            "city": "FLORENCE",
            "state": "MA",
            "postal_code": "010621346",
            "telephone_number": "413-303-9819"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "129 KING ST",
            "city": "NORTHAMPTON",
            "state": "MA",
            "postal_code": "010603258",
            "telephone_number": "413-586-0390"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BASTEK",
        "first_name": "SUSANNAH",
        "middle_name": "COBURN",
        "credential": "LICSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-01-18",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MA",
            "license": "113728",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Catherine E. Bartlett, MD
• Barton'S Angels, Inc.
• Scott Barvainis
• Vera Basford, LICSW
• Kathryn Karusaitis Basham, PH.D. LICSW
• Isabella Kaisla Amanda Batts
• Lisa Bauer
• Mallory Veronica Bauer
• Kelsey Baumgarten, RD
• Max Baumkel

• Clinical Social Worker in Northampton, MA
• Providers in Northampton, MA by specialty
• Clinical Social Worker in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.