Healthcare Provider Details

I. General information

NPI: 1932289923
Provider Name (Legal Business Name): RUTH D LAX MSW, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/16/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 N MAIN ST
MARLBORO NJ
07746-1429
US

IV. Provider business mailing address

23 GAINSBOROUGH CT
MANALAPAN NJ
07726-8955
US

V. Phone/Fax

Practice location:
  • Phone: 732-683-0904
  • Fax:
Mailing address:
  • Phone: 732-683-0904
  • Fax: 732-683-0277

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number44SC04408200
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberPR041513-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: