Individual
MRS. DESIREE DAWN RUSSELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
9 OVERLOOK RD, QUINCY, MA 02169-2315
(617) 770-1795
Mailing address
500 VICTORY RD, QUINCY, MA 02171-3139
(617) 745-2719
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
3476
MA
Other
Enumeration date
09/05/2014
Last updated
11/03/2015
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