Basic Information
| Provider Information | |||||||||
| NPI: | 1154768125 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BASKIN | ||||||||
| FirstName: | OLIVIA | ||||||||
| MiddleName: | MARLENE | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | LCSW | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | BASKIN | ||||||||
| OtherFirstName: | OLIVIA | ||||||||
| OtherMiddleName: | SKOPAL | ||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | LCSW | ||||||||
| OtherLastNameType: | 2 | ||||||||
| Mailing Information | |||||||||
| Address1: | 7011 ASPEN CREEK LN | ||||||||
| Address2: | |||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752522756 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2147690737 | ||||||||
| FaxNumber: | 9723989837 | ||||||||
| Practice Location | |||||||||
| Address1: | 12700 HILLCREST RD | ||||||||
| Address2: | 274 | ||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752302033 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9722331010 | ||||||||
| FaxNumber: | 9722331099 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/30/2013 | ||||||||
| LastUpdateDate: | 05/30/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 56810 | TX | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.