Provider Demographics
NPI:1346854502
Name:RUSSELL, HANNAH LEIGH
Entity Type:Individual
Prefix:
First Name:HANNAH
Middle Name:LEIGH
Last Name:RUSSELL
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 1:5 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:NESCONSET
Mailing Address - State:NY
Mailing Address - Zip Code:11767-1011
Mailing Address - Country:US
Mailing Address - Phone:631-672-5287
Mailing Address - Fax:
Practice Address - Street 1:225 BROADHOLLOW RD
Practice Address - Street 2:
Practice Address - City:MELVILLE
Practice Address - State:NY
Practice Address - Zip Code:11747-4822
Practice Address - Country:US
Practice Address - Phone:631-385-7795
Practice Address - Fax:631-385-7795
Is Sole Proprietor?:No
Enumeration Date:2020-09-04
Last Update Date:2020-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician