Provider Demographics
NPI:1124178595
Name:BACHMAN, BRENDA MARCIA (MSW)
Entity Type:Individual
Prefix:MS
First Name:BRENDA
Middle Name:MARCIA
Last Name:BACHMAN
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 APTHORP AVE
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:RI
Mailing Address - Zip Code:02840-1401
Mailing Address - Country:US
Mailing Address - Phone:401-847-6169
Mailing Address - Fax:401-846-1941
Practice Address - Street 1:19 FRIENDSHIP ST
Practice Address - Street 2:SUITE 240
Practice Address - City:NEWPORT
Practice Address - State:RI
Practice Address - Zip Code:02840-2200
Practice Address - Country:US
Practice Address - Phone:401-846-1192
Practice Address - Fax:401-846-1192
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIISOW001151041C0700X
RI338561041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Not Answered1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool