Provider Demographics
NPI:1841368115
Name:RAUP, JANA L (PHD, LCPC)
Entity type:Individual
Prefix:DR
First Name:JANA
Middle Name:L
Last Name:RAUP
Suffix:
Gender:F
Credentials:PHD, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 26
Mailing Address - Street 2:
Mailing Address - City:WEST RIVER
Mailing Address - State:MD
Mailing Address - Zip Code:20778-0026
Mailing Address - Country:US
Mailing Address - Phone:410-956-9468
Mailing Address - Fax:410-956-9581
Practice Address - Street 1:134 OWENSVILLE RD
Practice Address - Street 2:
Practice Address - City:WEST RIVER
Practice Address - State:MD
Practice Address - Zip Code:20778-9998
Practice Address - Country:US
Practice Address - Phone:410-956-9468
Practice Address - Fax:410-956-9581
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC0431101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD7266443OtherAETNA
MD264777000OtherMAGELLAN
MD4123855OtherMAMSI HEALTH PLANS
MD1Y32JLOtherBCBS MD
DCG335 0001OtherBCBS NATIONAL CAP. AREA
MD400629100Medicaid