Russell, Gerald Lee
Russell, Gerald Lee is an individual health care provider with primary practice located at 713 6Th St , Las Vegas NM 87701-4359. He recently has only one registered license in Behavioral Health & Social Service Providers / Clinical Neuropsychologist, which is considered as his primary health care specialty. Russell, Gerald Lee can be contacted via phone (505) 429-4679.Contact Information
Primary practice address
713 6Th St
Las Vegas NM 87701-4359
Phone: (505) 429-4679
Fax: (505) 425-3370
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Behavioral Health & Social Service Providers / Clinical Neuropsychologist | 103G00000X | 761 | New Mexico |
Profile Details
| NPI number | 1326040148 |
|---|---|
| LBN Legal business name | Russell, Gerald Lee |
| Credentials | PHD |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Aug 11th, 2005 |
| Last updated | Jul 8th, 2007 - about 19 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1326040148 | NPPES |
| New Mexico | MEDICAID | 76705 |
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