Provider Demographics
NPI:1144612268
Name:RAUCHWERGER, MISHA
Entity Type:Individual
Prefix:
First Name:MISHA
Middle Name:
Last Name:RAUCHWERGER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10784 CEDAR WAY
Mailing Address - Street 2:
Mailing Address - City:GRASS VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:95945-4833
Mailing Address - Country:US
Mailing Address - Phone:209-770-0701
Mailing Address - Fax:
Practice Address - Street 1:10784 CEDAR WAY
Practice Address - Street 2:
Practice Address - City:GRASS VALLEY
Practice Address - State:CA
Practice Address - Zip Code:95945-4833
Practice Address - Country:US
Practice Address - Phone:209-770-0701
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-26
Last Update Date:2015-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor