Provider Demographics
NPI:1528199809
Name:BACHRACH, PAMELA KEYES (LICSW)
Entity Type:Individual
Prefix:MS
First Name:PAMELA
Middle Name:KEYES
Last Name:BACHRACH
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 630
Mailing Address - Street 2:
Mailing Address - City:OTIS
Mailing Address - State:MA
Mailing Address - Zip Code:01253-0630
Mailing Address - Country:US
Mailing Address - Phone:413-623-5073
Mailing Address - Fax:
Practice Address - Street 1:33 BLACKFOOT WAY
Practice Address - Street 2:
Practice Address - City:BECKET
Practice Address - State:MA
Practice Address - Zip Code:01223
Practice Address - Country:US
Practice Address - Phone:413-623-5073
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MALICSW1058071041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAP03695OtherBCBS MA
MAP03695OtherBCBS MA