Provider Demographics
NPI:1023281292
Name:MCH/RUSSELL ASSOCIATES,LLC
Entity type:Organization
Organization Name:MCH/RUSSELL ASSOCIATES,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:RUSSELL
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:860-561-4841
Mailing Address - Street 1:1001 FARMINGTON AVE
Mailing Address - Street 2:SUITE 304
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06107-2135
Mailing Address - Country:US
Mailing Address - Phone:860-561-4841
Mailing Address - Fax:860-561-4891
Practice Address - Street 1:1001 FARMINGTON AVE
Practice Address - Street 2:SUITE 304
Practice Address - City:WEST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06107-2135
Practice Address - Country:US
Practice Address - Phone:860-561-4841
Practice Address - Fax:860-561-4891
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-09
Last Update Date:2008-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty