Basic Information
| Provider Information | |||||||||
| NPI: | 1003345364 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BASUALDO | ||||||||
| FirstName: | ASHLEY | ||||||||
| MiddleName: | MARGARET | ||||||||
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| Credential: | ASW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1001 POTRERO AVE # 6B | ||||||||
| Address2: | |||||||||
| City: | SAN FRANCISCO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 941103518 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4152065270 | ||||||||
| FaxNumber: | 4152064722 | ||||||||
| Practice Location | |||||||||
| Address1: | 1001 POTRERO AVE # 6B | ||||||||
| Address2: | |||||||||
| City: | SAN FRANCISCO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 941103518 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4152065270 | ||||||||
| FaxNumber: | 4152064722 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/08/2017 | ||||||||
| LastUpdateDate: | 09/09/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 09/09/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | 96598 | CA | Y | Behavioral Health & Social Service Providers | Counselor |
No ID Information.