Provider Demographics
NPI:1932727906
Name:CAROLINA BACCHI PSYCHOTHERAPY AND PSYCHOANALYSIS, LLC
Entity Type:Organization
Organization Name:CAROLINA BACCHI PSYCHOTHERAPY AND PSYCHOANALYSIS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CAROLINA
Authorized Official - Middle Name:
Authorized Official - Last Name:BACCHI
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:510-594-4314
Mailing Address - Street 1:23 WELLFLEET BAY
Mailing Address - Street 2:
Mailing Address - City:ALAMEDA
Mailing Address - State:CA
Mailing Address - Zip Code:94502-6459
Mailing Address - Country:US
Mailing Address - Phone:510-219-0391
Mailing Address - Fax:
Practice Address - Street 1:5665 COLLEGE AVE STE 340C
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94618-1658
Practice Address - Country:US
Practice Address - Phone:510-594-4314
Practice Address - Fax:510-356-2929
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-07
Last Update Date:2020-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty