Organization
EDGEWOOD CLINICAL SERVICES OF PLAINFIELD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ADAM RUSSO LCSW (EXECUTIVE DIRECTOR)
(630) 428-7890
Entity
Organization
Contact information
Practice address
14722 S NAPERVILLE RD, SUITE 112, PLAINFIELD, IL 60544-3302
(630) 428-7890
Mailing address
PO BOX 5222, NAPERVILLE, IL 60567-5222
(630) 428-7890
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
149010253
IL
Other
Enumeration date
11/06/2008
Last updated
11/06/2008
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