Provider Demographics
NPI:1144382581
Name:SMITH, MARY RUTH (LCSW)
Entity Type:Individual
Prefix:MS
First Name:MARY RUTH
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 LENAPE DR
Mailing Address - Street 2:
Mailing Address - City:LINCOLN PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07035-1932
Mailing Address - Country:US
Mailing Address - Phone:973-641-9458
Mailing Address - Fax:
Practice Address - Street 1:59 BEAVERBROOK RD
Practice Address - Street 2:SUITE 303D
Practice Address - City:LINCOLN PARK
Practice Address - State:NJ
Practice Address - Zip Code:07035-1794
Practice Address - Country:US
Practice Address - Phone:973-641-9458
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC052485001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical