Organization
KRISTEN RUSSELL, LCSW, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. KRISTEN RUSSELL LCSW (OWNER/MANAGER)
(860) 993-6347
Entity
Organization
Contact information
Practice address
2 PARK PLACE, GRANBY, CT 06035
(860) 993-6347
Mailing address
PO BOX 11, GRANBY, CT 06035-0011
(860) 993-6347
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
006269
CT
Other
Enumeration date
05/20/2016
Last updated
05/20/2016
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