Provider Demographics
NPI:1023617073
Name:RUSSELL, EMILY CATHERINE (NCSP)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:CATHERINE
Last Name:RUSSELL
Suffix:
Gender:F
Credentials:NCSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:260 COTTAGE ST STE 301
Mailing Address - Street 2:
Mailing Address - City:LITTLETON
Mailing Address - State:NH
Mailing Address - Zip Code:03561-4137
Mailing Address - Country:US
Mailing Address - Phone:603-444-3925
Mailing Address - Fax:603-444-6299
Practice Address - Street 1:25 HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:LISBON
Practice Address - State:NH
Practice Address - Zip Code:03585-6112
Practice Address - Country:US
Practice Address - Phone:603-730-2997
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-21
Last Update Date:2020-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH114276103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool