Healthcare Provider Details

I. General information

NPI: 1952879256
Provider Name (Legal Business Name): LISA C RUANE LCSW, CHT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/05/2018
Last Update Date: 02/04/2025
Certification Date:
Deactivation Date: 11/06/2018
Reactivation Date: 02/04/2025

III. Provider practice location address

334 KINDERKAMACK RD FL 2
ORADELL NJ
07649-2102
US

IV. Provider business mailing address

334 KINDERKAMACK RD FL 2
ORADELL NJ
07649-2102
US

V. Phone/Fax

Practice location:
  • Phone: 201-416-9043
  • Fax:
Mailing address:
  • Phone: 201-416-9043
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number44SC05623100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: