Provider Demographics
NPI:1164943650
Name:RUSSIS, MEGAN ARLENE
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:ARLENE
Last Name:RUSSIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 281
Mailing Address - Street 2:
Mailing Address - City:THORNDIKE
Mailing Address - State:MA
Mailing Address - Zip Code:01079-0281
Mailing Address - Country:US
Mailing Address - Phone:413-485-8430
Mailing Address - Fax:413-585-9765
Practice Address - Street 1:8 ATWOOD DR STE 201
Practice Address - Street 2:
Practice Address - City:NORTHAMPTON
Practice Address - State:MA
Practice Address - Zip Code:01060-4266
Practice Address - Country:US
Practice Address - Phone:413-582-0471
Practice Address - Fax:413-585-0965
Is Sole Proprietor?:No
Enumeration Date:2017-07-05
Last Update Date:2017-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker