Individual
HANNAH RUSSELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1115 W CHESTNUT ST, BROCKTON, MA 02301-7501
(508) 559-0473
Mailing address
283 WALNUT ST, ABINGTON, MA 02351-2622
(781) 336-7169
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
9693650
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CDW960531941
BLUE CROSS BLUE SHIELD
MA
Enumeration date
12/28/2017
Last updated
12/28/2017
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