Provider Demographics
NPI:1629014741
Name:RUCH, LYNNETTE G (PHD)
Entity Type:Individual
Prefix:DR
First Name:LYNNETTE
Middle Name:G
Last Name:RUCH
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 1:21 GABLE PARK RD
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17603
Mailing Address - Country:US
Mailing Address - Phone:717-872-2603
Mailing Address - Fax:
Practice Address - Street 1:2819O WILLOW STREET PIKE N
Practice Address - Street 2:
Practice Address - City:WILLOW STREET
Practice Address - State:PA
Practice Address - Zip Code:17584-9496
Practice Address - Country:US
Practice Address - Phone:717-464-1464
Practice Address - Fax:717-464-4348
Is Sole Proprietor?:No
Enumeration Date:2006-06-20
Last Update Date:2010-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS 006874 L103TC0700X
PAPS006874L103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA01442642Medicaid
PA750994Medicare ID - Type Unspecified