Provider Demographics
NPI:1376047449
Name:RUSH, ANDREA SUZANNE (LCSW)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:SUZANNE
Last Name:RUSH
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 1:703 COUNTY ROAD 625
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08827-4132
Mailing Address - Country:US
Mailing Address - Phone:908-303-8543
Mailing Address - Fax:
Practice Address - Street 1:703 COUNTY ROAD 625
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:NJ
Practice Address - Zip Code:08827-4132
Practice Address - Country:US
Practice Address - Phone:908-303-8543
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-22
Last Update Date:2018-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor