MEDICARE: ROLAND BARACH PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	555	WA

General Provider Information

NPI Number	:	1134278070
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROLAND BARACH PH.D.

Provider Business Mailing Address
First Line	:	PO BOX 1333
Second Line	:
City	:	MERCER ISLAND
State	:	WA
Zip	:	98040-1333
Country	:	US
Telephone Number	:	206-439-1762
Fax Number	:

Provider Business Practice Location Address
First Line	:	8015 SE 28TH ST
Second Line	:	#201
City	:	MERCER ISLAND
State	:	WA
Zip	:	98040-2910
Country	:	US
Telephone Number	:	206-439-1762
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/09/2007
Last Update Date	:	07/08/2007

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