Healthcare Provider Details

I. General information

NPI: 1790505600
Provider Name (Legal Business Name): MINIMAH A RUSH LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/15/2024
Last Update Date: 10/15/2024
Certification Date: 10/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

256 BROAD ST STE 2E
BLOOMFIELD NJ
07003-2766
US

IV. Provider business mailing address

444 WESTMINSTER AVE APT 30
ELIZABETH NJ
07208-3251
US

V. Phone/Fax

Practice location:
  • Phone: 201-632-5554
  • Fax: 844-866-6790
Mailing address:
  • Phone: 973-204-8108
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number44SC06386900
License Number StateNJ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: