Provider Demographics
NPI:1366605453
Name:BASIT, SHANTRINIA MARTRIECE (LCSW)
Entity type:Individual
Prefix:MRS
First Name:SHANTRINIA
Middle Name:MARTRIECE
Last Name:BASIT
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MRS
Other - First Name:SHANTRIANA
Other - Middle Name:MARTIECE
Other - Last Name:BASIT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:58375 S TWENTYNINE PALMS
Mailing Address - Street 2:
Mailing Address - City:YUCCA VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92284
Mailing Address - Country:US
Mailing Address - Phone:760-365-9305
Mailing Address - Fax:
Practice Address - Street 1:58375 S TWENTYNINE PALMS
Practice Address - Street 2:
Practice Address - City:YUCCA VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92284
Practice Address - Country:US
Practice Address - Phone:760-365-9305
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-08
Last Update Date:2022-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1041S0200X
CA883021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool