Provider Demographics
NPI:1245312156
Name:RAUH IVERS, ISABELLA (PHD)
Entity type:Individual
Prefix:MRS
First Name:ISABELLA
Middle Name:
Last Name:RAUH IVERS
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:ISABELLA RAUH IVERS PHD
Mailing Address - Street 2:600 OSWEGO STREET SUITE A
Mailing Address - City:LIVERPOOL
Mailing Address - State:NY
Mailing Address - Zip Code:13088
Mailing Address - Country:US
Mailing Address - Phone:315-451-0202
Mailing Address - Fax:315-451-6667
Practice Address - Street 1:ISABELLA RAUH IVERS PHD
Practice Address - Street 2:600 OSWEGO STREET SUITE A
Practice Address - City:LIVERPOOL
Practice Address - State:NY
Practice Address - Zip Code:13088
Practice Address - Country:US
Practice Address - Phone:315-451-0202
Practice Address - Fax:315-451-6667
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009715103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical