Provider Demographics
NPI:1194765099
Name:BACHENHEIMER, BARRY H (LCSW)
Entity type:Individual
Prefix:
First Name:BARRY
Middle Name:H
Last Name:BACHENHEIMER
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 JUDSON LANE
Mailing Address - Street 2:
Mailing Address - City:CAMPBELL HALL
Mailing Address - State:NY
Mailing Address - Zip Code:10916
Mailing Address - Country:US
Mailing Address - Phone:845-496-6029
Mailing Address - Fax:845-496-0976
Practice Address - Street 1:90 EAST MAIN ST
Practice Address - Street 2:
Practice Address - City:WASHINGTONVILLE
Practice Address - State:NY
Practice Address - Zip Code:10916
Practice Address - Country:US
Practice Address - Phone:845-496-6029
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYPR02756711041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN4941Medicare ID - Type Unspecified