Provider Demographics
NPI:1891298733
Name:BAXTER, RUSSELL MCGILL
Entity Type:Individual
Prefix:
First Name:RUSSELL
Middle Name:MCGILL
Last Name:BAXTER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 ESSEX ST # 33B
Mailing Address - Street 2:
Mailing Address - City:SOUTH HAMILTON
Mailing Address - State:MA
Mailing Address - Zip Code:01982-2325
Mailing Address - Country:US
Mailing Address - Phone:615-418-2622
Mailing Address - Fax:
Practice Address - Street 1:130 ESSEX ST # 33B
Practice Address - Street 2:
Practice Address - City:SOUTH HAMILTON
Practice Address - State:MA
Practice Address - Zip Code:01982-2325
Practice Address - Country:US
Practice Address - Phone:615-418-2622
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-16
Last Update Date:2018-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health