Russell, Jennifer

Russell, Jennifer is an individual health care provider with primary practice located at 85 Shell Edge Dr , Rochester NY 14623-4356. She recently has 2 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Clinical, Behavioral Health & Social Service Providers / School. Behavioral Health & Social Service Providers / Clinical is her primary health care specialty. Russell, Jennifer can be contacted via phone (585) 359-5400.

Contact Information

Primary practice address
85 Shell Edge Dr Rochester NY 14623-4356
Phone: (585) 359-5400
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Clinical 1041C0700X R047014-1 New York
Behavioral Health & Social Service Providers / School 1041S0200X

Profile Details

NPI number 1659664217
LBN Legal business name Russell, Jennifer
Credentials
Entity Individual
Sole proprietor 1 No
Enumeration date May 16th, 2011
Last updated May 18th, 2011 - about 15 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.

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Identifiers

StateTypeNumberIssuer
All States NPI 1659664217 NPPES
New York MEDICAID 166002034

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