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NPI Code Detail

MEDICARE: DR. RUSSELL ARTHUR SURVEYER PH.D.

MEDICARE: DR. RUSSELL ARTHUR SURVEYER PH.D.
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
1101YM0800XMental Health CounselorMALMHC 2066MA
2101YP1600XPastoral CounselorMALMHC 2066MA
3101YM0800XMental Health CounselorMHC00455RI

General Provider Information

NPI Number : 1699887901
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. RUSSELL ARTHUR SURVEYER PH.D.
Provider Business Mailing Address
First Line : 1620 WACHUSETT ST
Second Line :
City : JEFFERSON
State : MA
Zip : 01522-1302
Country : US
Telephone Number : 508-868-5609
Fax Number : 508-870-9991
Provider Business Practice Location Address
First Line : 52 CEDAR ST
Second Line :
City : WORCESTER
State : MA
Zip : 01609-2134
Country : US
Telephone Number : 508-868-5609
Fax Number : 508-870-9991
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/31/2006
Last Update Date : 09/01/2010

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