Provider Demographics
NPI:1962600668
Name:BACHMEYER, ELLEN R (LCSW)
Entity type:Individual
Prefix:
First Name:ELLEN
Middle Name:R
Last Name:BACHMEYER
Suffix:
Gender:F
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:PO BOX 2336
Mailing Address - Street 2:
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33468-2336
Mailing Address - Country:US
Mailing Address - Phone:352-209-6211
Mailing Address - Fax:561-745-7324
Practice Address - Street 1:270 CAMPBELL AVE
Practice Address - Street 2:
Practice Address - City:THE VILLAGES
Practice Address - State:FL
Practice Address - Zip Code:32162-5389
Practice Address - Country:US
Practice Address - Phone:352-209-6211
Practice Address - Fax:561-745-7324
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-05
Last Update Date:2014-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW32921041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLA1432ZMedicare PIN