Individual
RUSSELL P WIDDER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
148 S BRADFORD ST, DOVER, DE 19904-7318
(302) 736-1820
(302) 736-5016
Mailing address
160 EGRET LN, WYOMING, DE 19934-4002
(302) 736-1820
(302) 736-5016
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
Q1-0000180
DE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0000643973
—
DE
Enumeration date
07/09/2006
Last updated
07/09/2007
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