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General NPI Number Information
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NPI Number | 1396025268
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Entity Type | Individual
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Provider Name | RUSSELL A. HUDSON M.S.W.
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Gender | Male
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Dates
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Enumeration Date | 08/24/2011
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Last Update Date | 08/24/2011
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Provider Practice Location Address
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Address Line | 2120 N BEVERLY AVE
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City | TUCSON
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State | AZ
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Zip | 85712-2128
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Country | US
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Telephone | 520-232-7904
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Fax |
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Provider Business Mailing Address
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Address Line | 5860 N CERRADA CIRCA
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City | TUCSON
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State | AZ
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Zip | 85718-4116
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Country | US
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Telephone | 520-299-3977
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | RLCSW-15064
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | LICSW-1025011
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License Number State | MA
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