Provider Demographics
NPI:1386163574
Name:BASALDU, LORI (LASAC)
Entity type:Individual
Prefix:
First Name:LORI
Middle Name:
Last Name:BASALDU
Suffix:
Gender:F
Credentials:LASAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8322 E HARTFORD DR
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85255-5402
Mailing Address - Country:US
Mailing Address - Phone:480-712-4600
Mailing Address - Fax:602-425-7045
Practice Address - Street 1:8322 E HARTFORD DR
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85255-5402
Practice Address - Country:US
Practice Address - Phone:480-712-4600
Practice Address - Fax:602-425-7045
Is Sole Proprietor?:No
Enumeration Date:2017-09-19
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLASAC-13266101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)