Provider Demographics
NPI:1396773610
Name:BARACH, PETER (PHD)
Entity type:Individual
Prefix:DR
First Name:PETER
Middle Name:
Last Name:BARACH
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5851 PEARL RD STE 305
Mailing Address - Street 2:
Mailing Address - City:PARMA HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44130-2112
Mailing Address - Country:US
Mailing Address - Phone:440-845-9011
Mailing Address - Fax:440-845-9013
Practice Address - Street 1:5851 PEARL RD STE 305
Practice Address - Street 2:
Practice Address - City:PARMA HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44130-2112
Practice Address - Country:US
Practice Address - Phone:440-845-9011
Practice Address - Fax:440-845-9013
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-28
Last Update Date:2019-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3280103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH292525359002OtherMEDICAL MUTUAL OF OHIO
OH0553691Medicaid
OH4118406OtherAETNA
OH341471799030OtherCARESOURCE
OH62596OtherCIGNA BEHAVIORAL HEALTH
OH132388OtherANTHEM
OH132388OtherANTHEM