Provider Demographics
NPI:1235548132
Name:BARUCH, RACHEL LEVINE (PHD)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:LEVINE
Last Name:BARUCH
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5922 PINECROFT DRIVE
Mailing Address - Street 2:
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48322-2086
Mailing Address - Country:US
Mailing Address - Phone:617-710-5199
Mailing Address - Fax:
Practice Address - Street 1:2350 WASHTENAW AVE
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48104-4532
Practice Address - Country:US
Practice Address - Phone:617-710-5199
Practice Address - Fax:617-710-5199
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-05
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301016568103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical