Healthcare Provider Details

I. General information

NPI: 1245213495
Provider Name (Legal Business Name): RUSSELL CHARLES HUFF LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 11/22/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

88 GRANDVIEW AVE ADULT BEHAVIORAL HEALTH
WATERBURY CT
06708-2509
US

IV. Provider business mailing address

PO BOX 737
WOODBURY CT
06798-0737
US

V. Phone/Fax

Practice location:
  • Phone: 203-573-7265
  • Fax: 203-573-7578
Mailing address:
  • Phone: 203-573-6253
  • Fax: 203-573-7578

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number000664
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: