Provider Demographics
NPI:1316067374
Name:BASS-WICHELHAUS, HELENE (PHD)
Entity type:Individual
Prefix:DR
First Name:HELENE
Middle Name:
Last Name:BASS-WICHELHAUS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 EAST 86 STREET
Mailing Address - Street 2:1SW
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10028-1024
Mailing Address - Country:US
Mailing Address - Phone:212-996-0050
Mailing Address - Fax:
Practice Address - Street 1:108 E 86TH ST
Practice Address - Street 2:1SW
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10028-1024
Practice Address - Country:US
Practice Address - Phone:212-996-0050
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0118151041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP3192823OtherOXFORD
NYP3192823OtherOXFORD