Individual
GEORGE RUSSELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
77 COURT ST, BANGOR, ME 04401-4723
(207) 941-0879
(207) 941-0880
Mailing address
77 COURT ST, BANGOR, ME 04401-4723
(207) 941-0879
(207) 941-0880
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
LC7659
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
423840099
—
ME
Enumeration date
12/02/2008
Last updated
12/02/2008
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