Individual
BRIAN RUSSMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
1404 INDEPENDENCE LN, MOUNT DORA, FL 32757-6102
(772) 577-1883
Mailing address
1404 INDEPENDENCE LN, MOUNT DORA, FL 32757-6102
(772) 577-1883
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
SW12366
FL
Other
Enumeration date
10/27/2021
Last updated
10/27/2021
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