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General NPI Number Information
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NPI Number | 1023281292
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Entity Type | Organization
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Legal Business Name | MCH/RUSSELL ASSOCIATES,LLC
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Dates
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Enumeration Date | 04/09/2008
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Last Update Date | 04/09/2008
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Provider Practice Location Address
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Address Line | 1001 FARMINGTON AVE SUITE 304
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City | WEST HARTFORD
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State | CT
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Zip | 06107-2135
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Country | US
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Telephone | 860-561-4841
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Fax | 860-561-4891
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Provider Business Mailing Address
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Address Line | 1001 FARMINGTON AVE SUITE 304
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City | WEST HARTFORD
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State | CT
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Zip | 06107-2135
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Country | US
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Telephone | 860-561-4841
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Fax | 860-561-4891
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Authorized Official
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Title or Position | MEMBER
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Name | DR. DAVID MICHAEL RUSSELL
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Credential | PH.D
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Telephone | 860-561-4841
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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