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General NPI Number Information
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NPI Number | 1104648534
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Entity Type | Individual
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Provider Name | ERIC BERNARD RUSSELL ACSW
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Gender | Male
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Dates
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Enumeration Date | 10/28/2024
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Last Update Date | 03/07/2025
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Provider Practice Location Address
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Address Line | 15740 TURNBERRY ST
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City | MORENO VALLEY
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State | CA
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Zip | 92555-4903
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Country | US
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Telephone | 951-363-8449
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Fax |
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Provider Business Mailing Address
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Address Line | 5870 ARLINGTON AVE
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City | RIVERSIDE
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State | CA
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Zip | 92504-2037
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Country | US
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Telephone | 951-683-6596
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 126347
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License Number State | CA
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