Provider Demographics
NPI:1427011238
Name:BACHE, ROBERT A (MSSW LISW BCD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:A
Last Name:BACHE
Suffix:
Gender:M
Credentials:MSSW LISW BCD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:126 WELLINGTON PL
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45219-1710
Mailing Address - Country:US
Mailing Address - Phone:513-421-4089
Mailing Address - Fax:513-421-4941
Practice Address - Street 1:126 WELLINGTON PL
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45219-1710
Practice Address - Country:US
Practice Address - Phone:513-421-4089
Practice Address - Fax:513-421-4941
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-11
Last Update Date:2007-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI1480104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH00000038748OtherANTHEM
OHSW21331Medicare PIN
OH00000038748OtherANTHEM