Provider Demographics
NPI:1740244508
Name:RUSCHE, PHILIP G (MSW)
Entity Type:Individual
Prefix:MR
First Name:PHILIP
Middle Name:G
Last Name:RUSCHE
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:82 FRONT ST
Mailing Address - Street 2:
Mailing Address - City:ROSETO
Mailing Address - State:PA
Mailing Address - Zip Code:18013-1324
Mailing Address - Country:US
Mailing Address - Phone:610-248-0297
Mailing Address - Fax:
Practice Address - Street 1:54 S COMMERCE WAY STE 100
Practice Address - Street 2:
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18017-8966
Practice Address - Country:US
Practice Address - Phone:610-866-2020
Practice Address - Fax:610-866-2055
Is Sole Proprietor?:No
Enumeration Date:2006-04-17
Last Update Date:2018-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
104100000X
PACW0176561041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
PASW010990LOtherLICENSE NUMBER