1063231991 NPI number — MARJORIE MEYER SIEGEL RUSSELL MS COUNSELING

Table of content: MARJORIE MEYER SIEGEL RUSSELL MS COUNSELING (NPI 1063231991)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063231991 NPI number — MARJORIE MEYER SIEGEL RUSSELL MS COUNSELING

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RUSSELL
Provider First Name:
MARJORIE
Provider Middle Name:
MEYER SIEGEL
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MS COUNSELING
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1063231991
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/08/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8 CHARLES ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CENTERBROOK
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06409-1060
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
860-304-5107
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
17 INDUSTRIAL PARK RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CENTERBROOK
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06409-1063
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
860-304-5107
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/08/2024

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101Y00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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