Provider Demographics
NPI:1679138192
Name:BETH W RUSKE
Entity Type:Organization
Organization Name:BETH W RUSKE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BETH
Authorized Official - Middle Name:WELCH
Authorized Official - Last Name:RUSKE
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:856-265-1802
Mailing Address - Street 1:157 SUGARMAN AVE
Mailing Address - Street 2:
Mailing Address - City:MILLVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08332-9751
Mailing Address - Country:US
Mailing Address - Phone:856-265-1802
Mailing Address - Fax:
Practice Address - Street 1:157 SUGARMAN AVE
Practice Address - Street 2:
Practice Address - City:MILLVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08332-9751
Practice Address - Country:US
Practice Address - Phone:856-265-1802
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-09
Last Update Date:2019-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)