Healthcare Provider Details

I. General information

NPI: 1952211575
Provider Name (Legal Business Name): MR. ZACHARY THOMAS BACIU
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/08/2026
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2482 STATE ROUTE 534
SOUTHINGTON OH
44470-9604
US

IV. Provider business mailing address

2482 STATE ROUTE 534
SOUTHINGTON OH
44470-9604
US

V. Phone/Fax

Practice location:
  • Phone: 330-898-7480
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License NumberOH3383492
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: