Provider Demographics
NPI:1093257214
Name:RAUCH, JONATHAN MARCUS (LMSW, CASAC-T, CIP)
Entity Type:Individual
Prefix:MR
First Name:JONATHAN
Middle Name:MARCUS
Last Name:RAUCH
Suffix:
Gender:M
Credentials:LMSW, CASAC-T, CIP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:353 LEXINGTON AVE # 312
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-0941
Mailing Address - Country:US
Mailing Address - Phone:949-751-7282
Mailing Address - Fax:
Practice Address - Street 1:353 LEXINGTON AVE # 312
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-0941
Practice Address - Country:US
Practice Address - Phone:949-751-7282
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-07
Last Update Date:2021-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY096233-1104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker