Provider Demographics
NPI:1396025268
Name:HUDSON, RUSSELL A (MSW)
Entity Type:Individual
Prefix:MR
First Name:RUSSELL
Middle Name:A
Last Name:HUDSON
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5860 N CERRADA CIRCA
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85718-4116
Mailing Address - Country:US
Mailing Address - Phone:520-299-3977
Mailing Address - Fax:
Practice Address - Street 1:2120 N BEVERLY AVE
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-2128
Practice Address - Country:US
Practice Address - Phone:520-232-7904
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-24
Last Update Date:2011-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRLCSW-150641041C0700X
MALICSW-10250111041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical