Provider Demographics
NPI:1063231991
Name:RUSSELL, MARJORIE MEYER SIEGEL (MS COUNSELING)
Entity type:Individual
Prefix:
First Name:MARJORIE
Middle Name:MEYER SIEGEL
Last Name:RUSSELL
Suffix:
Gender:F
Credentials:MS COUNSELING
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 CHARLES ST
Mailing Address - Street 2:
Mailing Address - City:CENTERBROOK
Mailing Address - State:CT
Mailing Address - Zip Code:06409-1060
Mailing Address - Country:US
Mailing Address - Phone:860-304-5107
Mailing Address - Fax:
Practice Address - Street 1:17 INDUSTRIAL PARK RD
Practice Address - Street 2:
Practice Address - City:CENTERBROOK
Practice Address - State:CT
Practice Address - Zip Code:06409-1063
Practice Address - Country:US
Practice Address - Phone:860-304-5107
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-08
Last Update Date:2024-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor