Provider Demographics
NPI:1205663937
Name:BACH, CAMRYN ALEXIS (LSW)
Entity type:Individual
Prefix:
First Name:CAMRYN
Middle Name:ALEXIS
Last Name:BACH
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 LEHAVRE CT
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08619-4719
Mailing Address - Country:US
Mailing Address - Phone:347-424-0310
Mailing Address - Fax:
Practice Address - Street 1:2 PRINCESS RD STE 2L
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08648-2320
Practice Address - Country:US
Practice Address - Phone:347-424-0310
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-17
Last Update Date:2024-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL07187200104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker