Provider Demographics
NPI:1902901341
Name:AUERBACH, MARGERY RUTH (PHD)
Entity Type:Individual
Prefix:
First Name:MARGERY
Middle Name:RUTH
Last Name:AUERBACH
Suffix:
Gender:F
Credentials:PHD
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 208
Mailing Address - Street 2:
Mailing Address - City:CUTCHOGUE
Mailing Address - State:NY
Mailing Address - Zip Code:11935-0208
Mailing Address - Country:US
Mailing Address - Phone:516-527-2710
Mailing Address - Fax:
Practice Address - Street 1:160 HOWELLS ROAD
Practice Address - Street 2:SUITE 2
Practice Address - City:BAY SHORE
Practice Address - State:NY
Practice Address - Zip Code:11706
Practice Address - Country:US
Practice Address - Phone:631-647-7885
Practice Address - Fax:631-647-7893
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-13
Last Update Date:2015-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013027-1103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01767757Medicaid
NYS13027-8OtherWORKERS COMPENSATION
NYS13027-8OtherWORKERS COMPENSATION