Healthcare Provider Details

I. General information

NPI: 1497589238
Provider Name (Legal Business Name): MADISON ANN BRUCH LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2024
Last Update Date: 08/26/2024
Certification Date: 08/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

219 TAYLORS MILLS RD
MANALAPAN NJ
07726-3255
US

IV. Provider business mailing address

150 KINKADE DR
MIDDLETOWN NJ
07748-1133
US

V. Phone/Fax

Practice location:
  • Phone: 908-415-2042
  • Fax:
Mailing address:
  • Phone: 908-601-9726
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number44SL07164800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: