Provider Demographics
NPI:1043428469
Name:RAUCH, JENNIFER (LCSW INTERN)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:RAUCH
Suffix:
Gender:F
Credentials:LCSW INTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3477 ALANDER CT
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92010-5520
Mailing Address - Country:US
Mailing Address - Phone:818-648-9685
Mailing Address - Fax:
Practice Address - Street 1:3477 ALANDER CT
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92010-5520
Practice Address - Country:US
Practice Address - Phone:818-648-9685
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-18
Last Update Date:2023-08-10
Deactivation Date:2023-06-23
Deactivation Code:
Reactivation Date:2023-08-09
Provider Licenses
StateLicense IDTaxonomies
NV4814S1041C0700X
CAW1108191041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical