Provider Demographics
NPI:1942632724
Name:BIRCH, RAURIE ELIZABETH (PSYD)
Entity type:Individual
Prefix:
First Name:RAURIE
Middle Name:ELIZABETH
Last Name:BIRCH
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3512 QUENTIN RD
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11234-4231
Mailing Address - Country:US
Mailing Address - Phone:800-275-3243
Mailing Address - Fax:
Practice Address - Street 1:1444 MANSFIELD AVENUE
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59812-4231
Practice Address - Country:US
Practice Address - Phone:773-398-9962
Practice Address - Fax:406-243-6887
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-05
Last Update Date:2025-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY020171-1103TC0700X
MTPSY1993103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical