Individual
DORIS RENEE RUSSELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
27512 CASAC
Contact information
Practice address
3 COMMERCIAL PL, NEWBURGH, NY 12550-5306
(845) 220-2146
(845) 220-2121
Mailing address
3 COMMERCIAL PL, NEWBURGH, NY 12550-5306
(845) 220-2146
(845) 220-2121
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
27512
NY
Other
Enumeration date
07/16/2018
Last updated
07/16/2018
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