Provider Demographics
NPI:1437467479
Name:ELLEN R BACHMEYER LCSW LLC
Entity Type:Organization
Organization Name:ELLEN R BACHMEYER LCSW LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ELLEN
Authorized Official - Middle Name:R
Authorized Official - Last Name:BACHMEYER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:352-209-6211
Mailing Address - Street 1:PO BOX 770575
Mailing Address - Street 2:
Mailing Address - City:WINTER GARDEN
Mailing Address - State:FL
Mailing Address - Zip Code:34777-0575
Mailing Address - Country:US
Mailing Address - Phone:352-209-6211
Mailing Address - Fax:407-217-6632
Practice Address - Street 1:270 CAMPBELL AVE
Practice Address - Street 2:
Practice Address - City:THE VILLAGES
Practice Address - State:FL
Practice Address - Zip Code:32162-5389
Practice Address - Country:US
Practice Address - Phone:352-209-6211
Practice Address - Fax:407-217-6632
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-23
Last Update Date:2015-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW32921041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLDQ034AMedicare PIN