Provider Demographics
NPI:1205849544
Name:RUSSELL, ANTHONY DUKE (MA)
Entity Type:Individual
Prefix:MR
First Name:ANTHONY
Middle Name:DUKE
Last Name:RUSSELL
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2617 K ST
Mailing Address - Street 2:SUITE 250
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95816-5116
Mailing Address - Country:US
Mailing Address - Phone:916-443-1931
Mailing Address - Fax:916-443-0943
Practice Address - Street 1:2617 K ST
Practice Address - Street 2:SUITE 250
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95816-5116
Practice Address - Country:US
Practice Address - Phone:916-443-1931
Practice Address - Fax:916-443-0943
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 42048106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist