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Individual

DR. CAROL RUSS

Active
Sole proprietor

Provider details

NPI number
Gender
F
Credential
PH.D.

Contact information

Practice address
1767 GRAND AVE, SUITE 4, PACIFIC BEACH, CA 92109-4400
(858) 755-8206
Mailing address
1767 GRAND AVE, SUITE 4, PACIFIC BEACH, CA 92109-4400
(858) 755-8206

Taxonomy

Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
PSY6070
CA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
PSY6070
CLINICAL PSYCHOLOGIST
CA
Enumeration date
09/02/2005
Last updated
07/08/2007
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