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:
Health care specialties
| Specialty | Code | License # | 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 2 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1891196861 | NPPES |
| Connecticut | Other | 12094 | DPH LICENSURE- LCSW |
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