Healthcare Provider Details

I. General information

NPI: 1457639908
Provider Name (Legal Business Name): ELLEN MARIE RUBAN MSW, LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2011
Last Update Date: 08/02/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

390 MAIN RD.
MONTVILLE NJ
07045
US

IV. Provider business mailing address

P.O. BOX 336 C/O NEWBRIDGE SERVICES
POMPTON PLAINS NJ
07444
US

V. Phone/Fax

Practice location:
  • Phone: 973-316-9333
  • Fax: 973-316-5790
Mailing address:
  • Phone: 973-839-2520
  • Fax: 973-628-2240

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number44SL04662600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: