Provider Demographics
NPI:1063706158
Name:BACHRACH, JESSE (LCSW, MSW)
Entity type:Individual
Prefix:
First Name:JESSE
Middle Name:
Last Name:BACHRACH
Suffix:
Gender:M
Credentials:LCSW, MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 29526
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94604-9526
Mailing Address - Country:US
Mailing Address - Phone:510-736-4613
Mailing Address - Fax:
Practice Address - Street 1:4000 BROADWAY STE 4
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94611-5670
Practice Address - Country:US
Practice Address - Phone:510-736-4613
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-06
Last Update Date:2019-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA757281041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical