Healthcare Provider Details

I. General information

NPI: 1346951746
Provider Name (Legal Business Name): JULIANNA DOROTHY RUSH LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/07/2022
Last Update Date: 10/02/2026
Certification Date: 10/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

98 EAST AVE
NORWALK CT
06851-5029
US

IV. Provider business mailing address

100 EAST AVE
NORWALK CT
06851-5010
US

V. Phone/Fax

Practice location:
  • Phone: 475-266-3877
  • Fax:
Mailing address:
  • Phone: 475-266-3877
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number17399
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: