Provider Demographics
NPI:1306321849
Name:BACHMAN, INA (LICSW)
Entity type:Individual
Prefix:
First Name:INA
Middle Name:
Last Name:BACHMAN
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:69 CUMMINGS RD
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:MA
Mailing Address - Zip Code:02459-1754
Mailing Address - Country:US
Mailing Address - Phone:617-953-6373
Mailing Address - Fax:
Practice Address - Street 1:JFK FEDERAL BUILDING
Practice Address - Street 2:25 NEW SUDBURY ST
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02203
Practice Address - Country:US
Practice Address - Phone:617-953-6373
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-01
Last Update Date:2018-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10197811041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical