Provider Demographics
NPI:1225382864
Name:BASBAGILL, ABBY RENEE (MA, BCBA)
Entity type:Individual
Prefix:
First Name:ABBY
Middle Name:RENEE
Last Name:BASBAGILL
Suffix:
Gender:F
Credentials:MA, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4111 AVIS RD
Mailing Address - Street 2:
Mailing Address - City:NEW ALBANY
Mailing Address - State:OH
Mailing Address - Zip Code:43054-9514
Mailing Address - Country:US
Mailing Address - Phone:614-209-8268
Mailing Address - Fax:
Practice Address - Street 1:4111 AVIS RD
Practice Address - Street 2:
Practice Address - City:NEW ALBANY
Practice Address - State:OH
Practice Address - Zip Code:43054-9514
Practice Address - Country:US
Practice Address - Phone:614-209-8268
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-05
Last Update Date:2012-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1129772103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst