Russell, Jessica

Russell, Jessica is an individual health care provider with primary practice located at 15 Fairview Ave , Ellington CT 06029-4218. She recently has only one registered license in Behavioral Health & Social Service Providers / Clinical, which is considered as her primary health care specialty. Russell, Jessica can be contacted via phone (860) 559-7478.

Contact Information

Primary practice address
15 Fairview Ave Ellington CT 06029-4218
Phone: (860) 559-7478
Fax: (413) 439-0100
Website:
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Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Clinical 1041C0700X 12094 Connecticut
Behavioral Health & Social Service Providers / Clinical 1041C0700X

Profile Details

NPI number 1891196861
LBN Legal business name Russell, Jessica
Credentials Licensed Clinical Social Worker (LCSW)
Entity Individual
Sole proprietor 1 No
Enumeration date Sep 10th, 2014
Last updated Feb 6th, 2023 - about 3 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 1891196861 NPPES
Connecticut Other 12094 DPH LICENSURE- LCSW

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