Provider Demographics
NPI:1336756998
Name:BASTIEN, WILLIAM (SWT)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:
Last Name:BASTIEN
Suffix:
Gender:M
Credentials:SWT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1251 NILLES RD STE 5
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45014-7205
Mailing Address - Country:US
Mailing Address - Phone:513-939-0300
Mailing Address - Fax:513-939-0310
Practice Address - Street 1:1251 NILLES RD STE 5
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:OH
Practice Address - Zip Code:45014-7205
Practice Address - Country:US
Practice Address - Phone:513-939-0300
Practice Address - Fax:513-939-0310
Is Sole Proprietor?:No
Enumeration Date:2020-09-28
Last Update Date:2021-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS.21062081041C0700X
OHS.2001513-TRNE1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHS.2001513-TRNEOtherSWT