Provider Demographics
NPI:1669494928
Name:HARRINGTON, RUSSELL JOHN (LCSW)
Entity Type:Individual
Prefix:
First Name:RUSSELL
Middle Name:JOHN
Last Name:HARRINGTON
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:770 SAYBROOK RD
Mailing Address - Street 2:BUILDING B
Mailing Address - City:MIDDLETOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06457-4739
Mailing Address - Country:US
Mailing Address - Phone:860-343-5084
Mailing Address - Fax:860-343-5391
Practice Address - Street 1:770 SAYBROOK RD
Practice Address - Street 2:BUILDING B
Practice Address - City:MIDDLETOWN
Practice Address - State:CT
Practice Address - Zip Code:06457-4739
Practice Address - Country:US
Practice Address - Phone:860-343-5084
Practice Address - Fax:860-343-5391
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0029311041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTP2742837OtherOXFORD
CT185757OtherMHN/HMC
CT5898004OtherAETNA
CT127796OtherVALUE OPTIONS
CT140002931CT02OtherANTHEM
CTS54890OtherMAGELLAN