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General NPI Number Information
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NPI Number | 1730200767
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Entity Type | Individual
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Provider Name | TANYA RUSSO LCSW
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Gender | Female
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Dates
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Enumeration Date | 04/03/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 326 WASHINGTON ST WILLIAM W BACKUS HOSPITAL
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City | NORWICH
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State | CT
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Zip | 06360
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Country | US
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Telephone | 860-889-8331
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Fax | 860-892-6983
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Provider Business Mailing Address
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Address Line | 326 WASHINGTON ST WILLIAM W BACKUS HOSPITAL
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City | NORWICH
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State | CT
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Zip | 06360
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Country | US
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Telephone | 860-889-8331
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Fax | 860-892-6983
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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 | 006058
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License Number State | CT
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