Provider Demographics
NPI:1689933905
Name:RAUCH, MARC (PSYD)
Entity Type:Individual
Prefix:DR
First Name:MARC
Middle Name:
Last Name:RAUCH
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:978 ROUTE 45 STE 204
Mailing Address - Street 2:
Mailing Address - City:POMONA
Mailing Address - State:NY
Mailing Address - Zip Code:10970-3512
Mailing Address - Country:US
Mailing Address - Phone:845-362-0805
Mailing Address - Fax:
Practice Address - Street 1:978 ROUTE 45 STE 204
Practice Address - Street 2:
Practice Address - City:POMONA
Practice Address - State:NY
Practice Address - Zip Code:10970-3512
Practice Address - Country:US
Practice Address - Phone:845-362-0805
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-07
Last Update Date:2012-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015899-1103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist