Provider Demographics
NPI:1932289923
Name:LAX, RUTH D (MSW, LCSW)
Entity Type:Individual
Prefix:MS
First Name:RUTH
Middle Name:D
Last Name:LAX
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 GAINSBOROUGH CT
Mailing Address - Street 2:
Mailing Address - City:MANALAPAN
Mailing Address - State:NJ
Mailing Address - Zip Code:07726-8955
Mailing Address - Country:US
Mailing Address - Phone:732-683-0904
Mailing Address - Fax:732-683-0277
Practice Address - Street 1:30 N MAIN ST
Practice Address - Street 2:
Practice Address - City:MARLBORO
Practice Address - State:NJ
Practice Address - Zip Code:07746-1429
Practice Address - Country:US
Practice Address - Phone:732-683-0904
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC044082001041C0700X
NYPR041513-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
133396000OtherMAGELLAN BEHAVIORAL HEALT
6276465OtherUNITED BEHAVIORAL HEALTH
113784OtherVALUE OPTIONS HEALTH CARE
P1677617OtherOXFORD HEALTH CARE
6276465OtherUNITED BEHAVIORAL HEALTH
R98765Medicare UPIN