Provider Demographics
NPI:1518202217
Name:BACCHUS, FARAH Z (PHD, BCBA-D)
Entity Type:Individual
Prefix:DR
First Name:FARAH
Middle Name:Z
Last Name:BACCHUS
Suffix:
Gender:F
Credentials:PHD, BCBA-D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8040 PRAISE DR
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33625-3744
Mailing Address - Country:US
Mailing Address - Phone:773-454-1571
Mailing Address - Fax:813-688-0528
Practice Address - Street 1:8040 PRAISE DR
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33625-3744
Practice Address - Country:US
Practice Address - Phone:773-454-1571
Practice Address - Fax:813-688-0528
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-06
Last Update Date:2023-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-12-12197103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst