Provider Demographics
NPI:1891458782
Name:FORD-BROWN, RUSSELL J
Entity Type:Individual
Prefix:
First Name:RUSSELL
Middle Name:J
Last Name:FORD-BROWN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:RUSSELL
Other - Middle Name:J
Other - Last Name:FORD-BROWN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RUSSELL FORD-BROWN
Mailing Address - Street 1:66 PAVILION AVE
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02905-1522
Mailing Address - Country:US
Mailing Address - Phone:401-461-9110
Mailing Address - Fax:
Practice Address - Street 1:66 PAVILION AVE
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02905-1522
Practice Address - Country:US
Practice Address - Phone:401-461-9110
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-18
Last Update Date:2021-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)