Provider Demographics
NPI:1033405949
Name:BACHRACH, ROGER (LMHC , LMSW)
Entity Type:Individual
Prefix:MR
First Name:ROGER
Middle Name:
Last Name:BACHRACH
Suffix:
Gender:M
Credentials:LMHC , LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 E 79TH ST APT 24F
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10075-0945
Mailing Address - Country:US
Mailing Address - Phone:212-535-4717
Mailing Address - Fax:
Practice Address - Street 1:19 W 34TH ST
Practice Address - Street 2:PENTHOUSE
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-3006
Practice Address - Country:US
Practice Address - Phone:917-902-9203
Practice Address - Fax:212-239-0948
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-20
Last Update Date:2011-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY039729-1101Y00000X
NY000795-1101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor