Healthcare Provider Details

I. General information

NPI: 1447834569
Provider Name (Legal Business Name): RUSSELL MORGAN MARKS PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/06/2021
Last Update Date: 06/28/2021
Certification Date: 06/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 LOCKWOOD STREET POTTER BUILDING
PROVIDENCE RI
02903
US

IV. Provider business mailing address

427 WINTHROP ST UNIT 2
TAUNTON MA
02780-6721
US

V. Phone/Fax

Practice location:
  • Phone: 401-444-2128
  • Fax:
Mailing address:
  • Phone: 508-331-3846
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPS01961
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: