Provider Demographics
NPI:1497889745
Name:RUSSELL, WILLIAM P (MSW, LCSW, LMFT)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:P
Last Name:RUSSELL
Suffix:
Gender:M
Credentials:MSW, LCSW, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:618 LIBRARY PL
Mailing Address - Street 2:THE FAMILY INSTITUTE AT NORTHWESTERN UNIVERSITY
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60201-2908
Mailing Address - Country:US
Mailing Address - Phone:847-733-4300
Mailing Address - Fax:
Practice Address - Street 1:300 E 5TH AVE
Practice Address - Street 2:265
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60563-3177
Practice Address - Country:US
Practice Address - Phone:847-733-4300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1041C0700X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist