Provider Demographics
NPI:1356786917
Name:TRAUB, ERIC D (PSYD)
Entity type:Individual
Prefix:DR
First Name:ERIC
Middle Name:D
Last Name:TRAUB
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 1:1770 RAND RD
Mailing Address - Street 2:
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57702-9347
Mailing Address - Country:US
Mailing Address - Phone:605-791-1514
Mailing Address - Fax:844-831-2349
Practice Address - Street 1:1770 RAND RD
Practice Address - Street 2:
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57702-9347
Practice Address - Country:US
Practice Address - Phone:605-791-1514
Practice Address - Fax:844-831-2349
Is Sole Proprietor?:No
Enumeration Date:2013-05-08
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD508103TC0700X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical