Provider Demographics
NPI:1578755930
Name:RUSH, SANDRA (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:
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 1:6101 34TH ST.W.
Mailing Address - Street 2:UNIT 11G
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34210
Mailing Address - Country:US
Mailing Address - Phone:941-758-9183
Mailing Address - Fax:
Practice Address - Street 1:6101 34TH ST W
Practice Address - Street 2:UNIT 11G
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34210-3753
Practice Address - Country:US
Practice Address - Phone:941-758-9183
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-09
Last Update Date:2007-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW56341041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLZ0032Medicare UPIN