Provider Demographics
NPI:1750537460
Name:RAUSER, MARK (PSYD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:
Last Name:RAUSER
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 1:65 WAIAPO ST
Mailing Address - Street 2:
Mailing Address - City:KIHEI
Mailing Address - State:HI
Mailing Address - Zip Code:96753-7356
Mailing Address - Country:US
Mailing Address - Phone:773-301-6144
Mailing Address - Fax:
Practice Address - Street 1:1325 S KIHEI RD STE 218
Practice Address - Street 2:
Practice Address - City:KIHEI
Practice Address - State:HI
Practice Address - Zip Code:96753-8145
Practice Address - Country:US
Practice Address - Phone:808-818-3588
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-13
Last Update Date:2024-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071.007218103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI833865Medicaid