| Kristen Russell, Lcsw, Llc | |
|
2 Park Place Granby CT 06035 | |
| (860) 993-6347 | |
| Not Available |
| Full Name | Kristen Russell, Lcsw, Llc |
|---|---|
| Speciality | Social Worker - Clinical |
| Location | 2 Park Place, Granby, Connecticut |
| Authorized Official Name and Position | Kristen Russell (OWNER/MANAGER) |
| Authorized Official Contact | 8609936347 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Kristen Russell, Lcsw, Llc Po Box 11 Granby CT 06035-0011 Ph: (860) 993-6347 | Kristen Russell, Lcsw, Llc 2 Park Place Granby CT 06035 Ph: (860) 993-6347 |
| NPI Number | 1548617400 |
|---|---|
| Provider Enumeration Date | 05/20/2016 |
| Last Update Date | 05/20/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1548617400 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | 006269 (Connecticut) | Primary |
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