Organization
CHANGE TALK LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ADAM JOSEPH RUSSO MS (OWNER/CLINICIAN)
(860) 638-9169
Entity
Organization
Contact information
Practice address
251 ESSEX PLAZA, ESSEX, CT 06426
(860) 638-9169
(860) 469-2938
Mailing address
251 ESSEX PLAZA, ESSEX, CT 06426
(860) 638-9169
(860) 469-2938
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
101YM0800X
Mental Health Counselor
003050
CT
101YM0800X
Mental Health Counselor
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
008071044
—
CT
Enumeration date
02/10/2017
Last updated
07/23/2021
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