Provider Demographics
NPI:1225195084
Name:BACH, PATRICIA (PHD)
Entity Type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:
Last Name:BACH
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4835 27TH ST W STE 125
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34207-1759
Mailing Address - Country:US
Mailing Address - Phone:941-753-0064
Mailing Address - Fax:941-753-2977
Practice Address - Street 1:4835 27TH ST W STE 125
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34207-1759
Practice Address - Country:US
Practice Address - Phone:941-753-0064
Practice Address - Fax:941-753-2977
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2019-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY8777103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist