Provider Demographics
NPI:1659409985
Name:NEEDHAM, RUSSELL (MSW)
Entity Type:Individual
Prefix:MR
First Name:RUSSELL
Middle Name:
Last Name:NEEDHAM
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 1:414 W 54TH ST
Mailing Address - Street 2:APARTMENT 3D
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10019-4442
Mailing Address - Country:US
Mailing Address - Phone:212-246-5922
Mailing Address - Fax:212-243-3175
Practice Address - Street 1:322 8TH AVE
Practice Address - Street 2:SUITE 802
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-8001
Practice Address - Country:US
Practice Address - Phone:212-243-2830
Practice Address - Fax:212-243-3175
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYPR0L8369L1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical