Provider Demographics
NPI:1861616856
Name:TRUB, WILLIAM J (LCSW)
Entity type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:J
Last Name:TRUB
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:104 MIDSTREAMS ROAD
Mailing Address - Street 2:BRICK PSYCHOTHERAPY CENTER
Mailing Address - City:BRICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08724-3725
Mailing Address - Country:US
Mailing Address - Phone:732-477-6400
Mailing Address - Fax:732-295-9515
Practice Address - Street 1:104 MIDSTREAMS ROAD
Practice Address - Street 2:BRICK PSYCHOTHERAPY CENTER
Practice Address - City:BRICK
Practice Address - State:NJ
Practice Address - Zip Code:08724-3725
Practice Address - Country:US
Practice Address - Phone:732-477-6400
Practice Address - Fax:732-295-9515
Is Sole Proprietor?:No
Enumeration Date:2007-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC014606001041C0700X
NJ37F100106700106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
634485Medicare ID - Type Unspecified