Provider Demographics
NPI:1336803998
Name:BASARAB, ADRIANE (LCSW, CADC, CCS)
Entity type:Individual
Prefix:
First Name:ADRIANE
Middle Name:
Last Name:BASARAB
Suffix:
Gender:F
Credentials:LCSW, CADC, CCS
Other - Prefix:
Other - First Name:ADRIANE
Other - Middle Name:
Other - Last Name:SHULTZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LSW, CADC, CCS
Mailing Address - Street 1:109 E NEW ST UNIT A
Mailing Address - Street 2:
Mailing Address - City:MOUNTVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17554-1623
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1023 MUMMA RD STE 200
Practice Address - Street 2:
Practice Address - City:WORMLEYSBURG
Practice Address - State:PA
Practice Address - Zip Code:17043-1164
Practice Address - Country:US
Practice Address - Phone:717-522-6111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-28
Last Update Date:2025-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW135945101YA0400X, 101YM0800X
PACW0232221041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health