Provider Demographics
NPI:1205979101
Name:RAUCH, MIKELE (LMFT)
Entity type:Individual
Prefix:
First Name:MIKELE
Middle Name:
Last Name:RAUCH
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 BABCOCK ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02446-5903
Mailing Address - Country:US
Mailing Address - Phone:617-734-2007
Mailing Address - Fax:617-734-7165
Practice Address - Street 1:9 BABCOCK ST
Practice Address - Street 2:
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02446-5903
Practice Address - Country:US
Practice Address - Phone:617-734-2007
Practice Address - Fax:617-734-7165
Is Sole Proprietor?:No
Enumeration Date:2007-02-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC25787106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist