Organization Name: | KRISTEN RUSSELL, LCSW, LLC |
NPI Number: | 1548617400 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | KRISTEN RUSSELL (OWNER/MANAGER) |
Mailing Address: | 2 Park Place Granby |
State: | CT US |
Postal Code: | 06035 |
Phone Number: | 8609936347 |
Fax Number: | |
NPI Enumeration Date: | 05/20/2016 |
NPI Last Update Date: | 05/20/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 1041C0700X |
License Number: | 006269 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CT |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Social Worker |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: | A social worker who holds a master |