MEDICARE: MR. RUSSELL A. HUDSON M.S.W.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	RLCSW-15064	AZ
2	1041C0700X	Clinical Social Worker	LICSW-1025011	MA

General Provider Information

NPI Number	:	1396025268
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. RUSSELL A. HUDSON M.S.W.

Provider Business Mailing Address
First Line	:	5860 N CERRADA CIRCA
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85718-4116
Country	:	US
Telephone Number	:	520-299-3977
Fax Number	:

Provider Business Practice Location Address
First Line	:	2120 N BEVERLY AVE
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85712-2128
Country	:	US
Telephone Number	:	520-232-7904
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/24/2011
Last Update Date	:	08/24/2011

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