Healthcare Provider Details

I. General information

NPI: 1043428469
Provider Name (Legal Business Name): JENNIFER RAUCH LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2007
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date: 06/23/2023
Reactivation Date: 08/09/2023

III. Provider practice location address

2271 ALPINE BLVD STE A
ALPINE CA
91901-1101
US

IV. Provider business mailing address

3477 ALANDER CT
CARLSBAD CA
92010-5520
US

V. Phone/Fax

Practice location:
  • Phone: 818-648-9685
  • Fax:
Mailing address:
  • Phone: 818-648-9685
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number4814S
License Number StateNV
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number110819
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: