1669534624 NPI number — MS. KRISTEN DONNA RUSSELL LCSW

Table of content: MS. KRISTEN DONNA RUSSELL LCSW (NPI 1669534624)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669534624 NPI number — MS. KRISTEN DONNA RUSSELL LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RUSSELL
Provider First Name:
KRISTEN
Provider Middle Name:
DONNA
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
KOWALSKI
Provider Other First Name:
KRISTEN
Provider Other Middle Name:
DONNA
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1669534624
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/05/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
500 VINE ST
Provider Second Line Business Mailing Address:
CAPITOL REGION MENTAL HEALTH CENTER
Provider Business Mailing Address City Name:
HARTFORD
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06112-1639
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
860-293-6330
Provider Business Mailing Address Fax Number:
860-297-0915

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
500 VINE ST
Provider Second Line Business Practice Location Address:
CAPITOL REGION MENTAL HEALTH CENTER
Provider Business Practice Location Address City Name:
HARTFORD
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06112-1639
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
860-293-6330
Provider Business Practice Location Address Fax Number:
860-297-0915
Provider Enumeration Date:
12/15/2006

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: 1041C0700X , with the licence number:  006269 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com