Provider Demographics
NPI:1225782048
Name:CHURCH, RUSLANA (LCSW)
Entity Type:Individual
Prefix:PROF
First Name:RUSLANA
Middle Name:
Last Name:CHURCH
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 1:50 E SUMMIT AVE
Mailing Address - Street 2:
Mailing Address - City:SEWAREN
Mailing Address - State:NJ
Mailing Address - Zip Code:07077-1251
Mailing Address - Country:US
Mailing Address - Phone:718-954-0491
Mailing Address - Fax:
Practice Address - Street 1:540 RTE 22
Practice Address - Street 2:
Practice Address - City:BRIDGEWATER
Practice Address - State:NJ
Practice Address - Zip Code:08807-2405
Practice Address - Country:US
Practice Address - Phone:718-954-0491
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-10
Last Update Date:2022-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC057241001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical