Provider Demographics
NPI:1811631062
Name:BACHARACH, PAMELA RAE (MS,LAC)
Entity Type:Individual
Prefix:MS
First Name:PAMELA
Middle Name:RAE
Last Name:BACHARACH
Suffix:
Gender:F
Credentials:MS,LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 CHELSEA AVE APT 401
Mailing Address - Street 2:
Mailing Address - City:LONG BRANCH
Mailing Address - State:NJ
Mailing Address - Zip Code:07740-8110
Mailing Address - Country:US
Mailing Address - Phone:267-280-3918
Mailing Address - Fax:
Practice Address - Street 1:1088 NJ-34
Practice Address - Street 2:
Practice Address - City:ABERDEEN TOWNSHIP
Practice Address - State:NJ
Practice Address - Zip Code:07747
Practice Address - Country:US
Practice Address - Phone:732-290-1700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-25
Last Update Date:2022-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37AC00620600101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health