Provider Demographics
NPI:1285648907
Name:BACHAY, JOHN DANIEL (LCSW)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:DANIEL
Last Name:BACHAY
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2999 NE 191ST ST
Mailing Address - Street 2:SUITE 702
Mailing Address - City:AVENTURA
Mailing Address - State:FL
Mailing Address - Zip Code:33180-3123
Mailing Address - Country:US
Mailing Address - Phone:305-466-1998
Mailing Address - Fax:305-466-1960
Practice Address - Street 1:2999 NE 191ST ST
Practice Address - Street 2:SUITE 702
Practice Address - City:AVENTURA
Practice Address - State:FL
Practice Address - Zip Code:33180-3123
Practice Address - Country:US
Practice Address - Phone:305-466-1998
Practice Address - Fax:305-466-1960
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL16331041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLZ2515Medicare ID - Type UnspecifiedBC/BS OF FL/MEDICARE PROV