Healthcare Provider Details

I. General information

NPI: 1528670098
Provider Name (Legal Business Name): DAVID BACHARACH BCBA,LBA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2020
Last Update Date: 05/07/2024
Certification Date: 05/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31 WALKER AVE
BALTIMORE MD
21208-4022
US

IV. Provider business mailing address

3301 PINKNEY RD
BALTIMORE MD
21215-3712
US

V. Phone/Fax

Practice location:
  • Phone: 410-415-3515
  • Fax:
Mailing address:
  • Phone: 732-740-7172
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: