MEDICARE: SANDY BACHARACH

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	106H00000X	Marriage & Family Therapist

General Provider Information

NPI Number	:	1144117425
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SANDY BACHARACH

Provider Business Mailing Address
First Line	:	3622 NE 18TH AVE
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97212-2371
Country	:	US
Telephone Number	:	503-287-6927
Fax Number	:

Provider Business Practice Location Address
First Line	:	3622 NE 18TH AVE
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97212-2371
Country	:	US
Telephone Number	:	503-287-6927
Fax Number	:

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

Provider Enumeration Date	:	06/19/2025
Last Update Date	:	06/19/2025

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Directions to “ SANDY BACHARACH ” Practice Location

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