Provider Demographics
NPI:1437200888
Name:BACHA, REBECCA (MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:BACHA
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:543 N MAIN ST STE A
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:CT
Mailing Address - Zip Code:06042-1973
Mailing Address - Country:US
Mailing Address - Phone:860-978-4843
Mailing Address - Fax:860-649-6751
Practice Address - Street 1:543 N MAIN ST STE A
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:CT
Practice Address - Zip Code:06042-1973
Practice Address - Country:US
Practice Address - Phone:860-978-4843
Practice Address - Fax:860-649-6751
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-14
Last Update Date:2020-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT005907104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004253829Medicaid