Provider Demographics
NPI:1932490752
Name:BACCHI, CAROLINA (PSYD)
Entity Type:Individual
Prefix:DR
First Name:CAROLINA
Middle Name:
Last Name:BACCHI
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5665 COLLEGE AVE STE 340C
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94618-1658
Mailing Address - Country:US
Mailing Address - Phone:510-594-4314
Mailing Address - Fax:510-356-2929
Practice Address - Street 1:3120 TELEGRAPH AVE STE 1
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94705-1964
Practice Address - Country:US
Practice Address - Phone:510-594-4314
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-27
Last Update Date:2020-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY23258103TC2200X, 103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent