Provider Demographics
NPI:1396894994
Name:ADAMS, RUSSELL E (LISW)
Entity type:Individual
Prefix:
First Name:RUSSELL
Middle Name:E
Last Name:ADAMS
Suffix:
Gender:M
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 EUBANK BLVD NE
Mailing Address - Street 2:SUITE 6
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87112-5386
Mailing Address - Country:US
Mailing Address - Phone:505-292-1554
Mailing Address - Fax:505-292-1574
Practice Address - Street 1:1201 EUBANK BLVD NE
Practice Address - Street 2:SUITE 6
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87112-5386
Practice Address - Country:US
Practice Address - Phone:505-292-1554
Practice Address - Fax:505-292-1574
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMI-054931041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical