Individual
MS. ANTOINETTE MAXINE RUSSELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMSW
Contact information
Practice address
17545 88TH AVE, APT # 4G, JAMAICA, NY 11432-5759
(917) 587-5550
Mailing address
17545 88TH AVE, APT # 4G, JAMAICA, NY 11432-5759
(917) 587-5550
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
0805301-1
NY
Other
Enumeration date
04/29/2013
Last updated
04/29/2013
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