Individual
JANET RUSSELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
BS
Contact information
Practice address
315 N LAKEMONT AVE, STE B, WINTER PARK, FL 32792-3205
(407) 830-6412
Mailing address
315 N LAKEMONT AVE, STE B, WINTER PARK, FL 32792-3205
(407) 830-6412
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
593595260
—
FL
Enumeration date
06/06/2012
Last updated
06/06/2012
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