Provider Demographics
NPI:1316294861
Name:BASCH, EMMA G (PSYD)
Entity type:Individual
Prefix:DR
First Name:EMMA
Middle Name:G
Last Name:BASCH
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3768 MCKINLEY ST NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20015-2510
Mailing Address - Country:US
Mailing Address - Phone:202-630-5066
Mailing Address - Fax:
Practice Address - Street 1:3768 MCKINLEY ST NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20015-2510
Practice Address - Country:US
Practice Address - Phone:202-630-5066
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-14
Last Update Date:2022-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019697103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical