Provider Demographics
NPI:1801824818
Name:RUSSELL, MARGARET LOUISE (PHD)
Entity Type:Individual
Prefix:DR
First Name:MARGARET
Middle Name:LOUISE
Last Name:RUSSELL
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:MARLOU
Other - Middle Name:
Other - Last Name:RUSSELL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:1452 26TH ST
Mailing Address - Street 2:SUITE 103
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90404-3084
Mailing Address - Country:US
Mailing Address - Phone:310-829-1438
Mailing Address - Fax:310-476-1963
Practice Address - Street 1:1452 26TH ST
Practice Address - Street 2:SUITE 103
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404-3084
Practice Address - Country:US
Practice Address - Phone:310-829-1438
Practice Address - Fax:310-476-1963
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY12147103TC0700X
CAMFT19599106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist