Healthcare Provider Details

I. General information

NPI: 1285908848
Provider Name (Legal Business Name): NICOLE ORELLA BACHMAN LISW-S
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: NICOLE ORELLA PIERSON

II. Dates (important events)

Enumeration Date: 02/29/2012
Last Update Date: 03/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 PERKINS SQ
AKRON OH
44308-1063
US

IV. Provider business mailing address

3848 BAINBRIDGE DR
MEDINA OH
44256-5979
US

V. Phone/Fax

Practice location:
  • Phone: 330-543-5015
  • Fax: 330-543-7474
Mailing address:
  • Phone: 440-785-0240
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberS.0901307
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI.1200361
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: