Provider Demographics
NPI:1245213495
Name:HUFF, RUSSELL CHARLES (LPC)
Entity type:Individual
Prefix:
First Name:RUSSELL
Middle Name:CHARLES
Last Name:HUFF
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 737
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06798-0737
Mailing Address - Country:US
Mailing Address - Phone:203-573-6253
Mailing Address - Fax:203-573-7578
Practice Address - Street 1:88 GRANDVIEW AVE
Practice Address - Street 2:ADULT BEHAVIORAL HEALTH
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06708-2509
Practice Address - Country:US
Practice Address - Phone:203-573-7265
Practice Address - Fax:203-573-7578
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000664101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health