Provider Demographics
NPI:1093017071
Name:BACHRACH, JEAN ELLEN (BCBA)
Entity type:Individual
Prefix:MRS
First Name:JEAN
Middle Name:ELLEN
Last Name:BACHRACH
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:777 BRIARWOOD DR
Mailing Address - Street 2:
Mailing Address - City:HAVERHILL
Mailing Address - State:FL
Mailing Address - Zip Code:33415-1351
Mailing Address - Country:US
Mailing Address - Phone:561-683-3895
Mailing Address - Fax:
Practice Address - Street 1:500 NE SPANISH RIVER BLVD
Practice Address - Street 2:STE 12
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33431-4515
Practice Address - Country:US
Practice Address - Phone:561-391-1004
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-11-24
Last Update Date:2010-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst