Provider Demographics
NPI:1255530804
Name:ROLAND I BARACH PHD PS
Entity type:Organization
Organization Name:ROLAND I BARACH PHD PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROLAND
Authorized Official - Middle Name:
Authorized Official - Last Name:BARACH
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:206-439-1762
Mailing Address - Street 1:PO BOX 1333
Mailing Address - Street 2:
Mailing Address - City:MERCER ISLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98040-1333
Mailing Address - Country:US
Mailing Address - Phone:206-439-1762
Mailing Address - Fax:
Practice Address - Street 1:8015 SE 28TH ST
Practice Address - Street 2:#201
Practice Address - City:MERCER ISLAND
Practice Address - State:WA
Practice Address - Zip Code:98040-2910
Practice Address - Country:US
Practice Address - Phone:206-439-1762
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-13
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA583103TC0700X
WA555103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAAB21273Medicare PIN