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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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