| Benjaminrussack | |
|
20 Shelley Dr Apt 6 Mill Valley CA 94941-1562 | |
| (415) 497-1908 | |
| Not Available |
| Full Name | Benjaminrussack |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 20 Shelley Dr Apt 6, Mill Valley, California |
| Authorized Official Name and Position | Benjamin D Russack (MFT) |
| Authorized Official Contact | 4154971908 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Benjaminrussack 20 Shelley Dr Apt 6 Mill Valley CA 94941-1562 Ph: (415) 497-1908 | Benjaminrussack 20 Shelley Dr Apt 6 Mill Valley CA 94941-1562 Ph: (415) 497-1908 |
| NPI Number | 1083014773 |
|---|---|
| Provider Enumeration Date | 08/29/2014 |
| Last Update Date | 08/29/2014 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1083014773 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | 78602 (California) | Primary |
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