Provider Demographics
NPI:1134234701
Name:RAUSCH, FERNANDO CLAUDIO (LCSW)
Entity type:Individual
Prefix:MR
First Name:FERNANDO
Middle Name:CLAUDIO
Last Name:RAUSCH
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 MONTCLAIR DR
Mailing Address - Street 2:
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06107-1246
Mailing Address - Country:US
Mailing Address - Phone:860-231-1282
Mailing Address - Fax:860-216-6652
Practice Address - Street 1:682 PROSPECT AVE
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06105-4238
Practice Address - Country:US
Practice Address - Phone:860-231-1282
Practice Address - Fax:860-216-6652
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0047971041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004213310OtherCT BHP-MEDICAID
CT004213310OtherCT BHP-MEDICAID