Provider Demographics
NPI:1700860525
Name:BACHELLER, CHERYL L (PHD APRN BC)
Entity Type:Individual
Prefix:MRS
First Name:CHERYL
Middle Name:L
Last Name:BACHELLER
Suffix:
Gender:F
Credentials:PHD APRN BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 FEDERAL ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:SALEM
Mailing Address - State:MA
Mailing Address - Zip Code:01970
Mailing Address - Country:US
Mailing Address - Phone:978-740-9590
Mailing Address - Fax:978-744-5486
Practice Address - Street 1:30 FEDERAL ST
Practice Address - Street 2:SUITE B
Practice Address - City:SALEM
Practice Address - State:MA
Practice Address - Zip Code:01970
Practice Address - Country:US
Practice Address - Phone:978-740-9590
Practice Address - Fax:978-744-5486
Is Sole Proprietor?:No
Enumeration Date:2005-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA6181103T00000X
MA137539364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist
Not Answered364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1898515Medicaid
MA1898515Medicaid