Provider Demographics
NPI:1437313418
Name:ROTHENBERG RAUCH, PHYLLIS (MS)
Entity Type:Individual
Prefix:MRS
First Name:PHYLLIS
Middle Name:
Last Name:ROTHENBERG RAUCH
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:PHYLLIS
Other - Middle Name:
Other - Last Name:RAUCH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:515 W END AVE
Mailing Address - Street 2:SUITE 1A
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10024-4345
Mailing Address - Country:US
Mailing Address - Phone:212-595-0242
Mailing Address - Fax:
Practice Address - Street 1:515 W END AVE
Practice Address - Street 2:SUITE 1A
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10024-4345
Practice Address - Country:US
Practice Address - Phone:212-595-0242
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-18
Last Update Date:2008-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000087102L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst