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General NPI Number Information
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NPI Number | 1255185989
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Entity Type | Individual
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Provider Name | HEATHER RUSSELL
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Gender | Female
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Dates
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Enumeration Date | 04/17/2024
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Last Update Date | 04/17/2024
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Provider Practice Location Address
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Address Line | 332 E 4TH ST
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City | JAMESTOWN
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State | NY
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Zip | 14701-5598
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Country | US
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Telephone | 716-951-2274
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Fax | 716-483-6878
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Provider Business Mailing Address
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Address Line | 332 E 4TH ST
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City | JAMESTOWN
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State | NY
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Zip | 14701-5598
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Country | US
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Telephone | 716-488-1971
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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 | P127915
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License Number State | NY
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