Organization
BENJAMINRUSSACK
Active
Organization
BENJAMINRUSSACK
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. BENJAMIN D RUSSACK (MFT)
(415) 497-1908
Entity
Organization
Contact information
Practice address
20 SHELLEY DR APT 6, MILL VALLEY, CA 94941-1562
(415) 497-1908
Mailing address
20 SHELLEY DR APT 6, MILL VALLEY, CA 94941-1562
(415) 497-1908
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
78602
CA
Other
Enumeration date
08/29/2014
Last updated
08/29/2014
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