Individual
THOMAS J RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
44 FRONT ST, SUITE 490, WORCESTER, MA 01608-1733
(508) 799-2934
Mailing address
519 E RIVER ST, #18, ORANGE, MA 01364-2106
(978) 544-1897
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
Other
Enumeration date
06/28/2012
Last updated
06/28/2012
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