Individual
HAROLD RUSSELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
611 CANTERBURY RD, MILFORD, DE 19963-5336
(302) 573-1247
Mailing address
611 CANTERBURY RD, MILFORD, DE 19963-5336
(302) 573-1247
Taxonomy
Speciality
Code
Description
License number
State
103TM1800X
Intellectual & Developmental Disabilities Psychologist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000000536
—
DE
Enumeration date
11/24/2020
Last updated
11/24/2020
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