Provider Demographics
NPI:1053183293
Name:BASSETT, SHANTE ANTOINETTE (PSYD)
Entity type:Individual
Prefix:DR
First Name:SHANTE
Middle Name:ANTOINETTE
Last Name:BASSETT
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 1:22 HAPPY HOLLOW CIR UNIT B
Mailing Address - Street 2:
Mailing Address - City:STRATFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06614-8411
Mailing Address - Country:US
Mailing Address - Phone:917-975-1822
Mailing Address - Fax:
Practice Address - Street 1:3 ARMSTRONG RD # 1102
Practice Address - Street 2:
Practice Address - City:SHELTON
Practice Address - State:CT
Practice Address - Zip Code:06484-4706
Practice Address - Country:US
Practice Address - Phone:516-500-3119
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-23
Last Update Date:2023-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY026025103TC0700X
CT4640103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical