Provider Demographics
NPI:1568693851
Name:RAUCKHORST, JUDY MARION (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:JUDY
Middle Name:MARION
Last Name:RAUCKHORST
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10225 ULMERTON RD
Mailing Address - Street 2:SUITE 7-A
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33771-3538
Mailing Address - Country:US
Mailing Address - Phone:727-474-3740
Mailing Address - Fax:727-474-3741
Practice Address - Street 1:10225 ULMERTON RD
Practice Address - Street 2:SUITE 7-A
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33771-3538
Practice Address - Country:US
Practice Address - Phone:727-474-3740
Practice Address - Fax:727-474-3741
Is Sole Proprietor?:No
Enumeration Date:2009-08-04
Last Update Date:2010-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW - 54571041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical