Healthcare Provider Details

I. General information

NPI: 1972595817
Provider Name (Legal Business Name): MARY ANNE RUANE MSW, LCSW, CADC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/17/2005
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

268 BROAD ST SUITE 2E
RED BANK NJ
07701-2003
US

IV. Provider business mailing address

268 BROAD ST SUITE 2E
RED BANK NJ
07701-2003
US

V. Phone/Fax

Practice location:
  • Phone: 732-747-4333
  • Fax: 743-747-0095
Mailing address:
  • Phone: 732-747-4333
  • Fax: 743-747-0095

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number44SC00086700
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number37CA00025900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: