Individual
DORIS M RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PH.D.
Contact information
Practice address
100 LEDGEHILL RD, BENNINGTON, VT 05201-2273
(802) 442-5491
(802) 442-3363
Mailing address
100 LEDGEHILL RD, BENNINGTON, VT 05201-2273
(802) 442-5491
(802) 442-3363
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
048-0000574
VT
103TC0700X
Clinical Psychologist
Primary
048-0000574
VT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0VN0552
—
VT
01
—
10022260
CDPHP
—
01
—
1047191
CIGNA
—
01
—
29292
BLUE CROSS
—
01
—
359506
MANAGED HEALTH NET
—
Enumeration date
07/21/2006
Last updated
10/02/2015
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