Provider Demographics
NPI:1104281369
Name:RUSSO, ADAM J (MS)
Entity type:Individual
Prefix:
First Name:ADAM
Middle Name:J
Last Name:RUSSO
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:251 ESSEX PLZ
Mailing Address - Street 2:
Mailing Address - City:ESSEX
Mailing Address - State:CT
Mailing Address - Zip Code:06426-1400
Mailing Address - Country:US
Mailing Address - Phone:860-638-9169
Mailing Address - Fax:860-469-2938
Practice Address - Street 1:251 ESSEX PLZ
Practice Address - Street 2:
Practice Address - City:ESSEX
Practice Address - State:CT
Practice Address - Zip Code:06426-1400
Practice Address - Country:US
Practice Address - Phone:860-638-9169
Practice Address - Fax:860-469-2938
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-15
Last Update Date:2021-07-03
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health