Individual
DR. STEPHEN FORREST RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHD
Contact information
Practice address
4700 N. HABANA AVE., SUITE 300, TAMPA, FL 33614-7160
(813) 870-0392
(813) 871-6305
Mailing address
4700 N. HABANA AVE., SUITE 300, TAMPA, FL 33614-7160
(813) 870-0392
(813) 871-6305
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
PY0003453
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
39977
BCBS GRP
FL
01
—
73684
BCBS
FL
Enumeration date
05/24/2006
Last updated
07/08/2007
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