Provider Demographics
NPI:1477961761
Name:JENABETH RUSH MD, LPC LLC
Entity type:Organization
Organization Name:JENABETH RUSH MD, LPC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JENABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:RUSH
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:860-883-9512
Mailing Address - Street 1:128 SILKEY RD
Mailing Address - Street 2:
Mailing Address - City:NORTH GRANBY
Mailing Address - State:CT
Mailing Address - Zip Code:06060-1418
Mailing Address - Country:US
Mailing Address - Phone:860-883-9512
Mailing Address - Fax:
Practice Address - Street 1:1080 DAY HILL RD
Practice Address - Street 2:
Practice Address - City:WINDSOR
Practice Address - State:CT
Practice Address - Zip Code:06095-1781
Practice Address - Country:US
Practice Address - Phone:860-883-9512
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-30
Last Update Date:2014-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT2509101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty