Provider Demographics
NPI:1477043487
Name:RUSS-CARBIN, ANGELEE (MSW, MPH)
Entity Type:Individual
Prefix:MS
First Name:ANGELEE
Middle Name:
Last Name:RUSS-CARBIN
Suffix:
Gender:F
Credentials:MSW, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:63 CUSHING ST
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02138-4581
Mailing Address - Country:US
Mailing Address - Phone:617-237-6168
Mailing Address - Fax:
Practice Address - Street 1:63 CUSHING ST
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02138-4581
Practice Address - Country:US
Practice Address - Phone:617-237-6168
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-15
Last Update Date:2022-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1198471041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical