Provider Demographics
NPI:1396948667
Name:RUSSELL, ANDREA (LICSW)
Entity type:Individual
Prefix:MRS
First Name:ANDREA
Middle Name:
Last Name:RUSSELL
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:MS
Other - First Name:ANDREA
Other - Middle Name:
Other - Last Name:WEISMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LICSW
Mailing Address - Street 1:65 E WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:NORTH ATTLEBORO
Mailing Address - State:MA
Mailing Address - Zip Code:02760-2330
Mailing Address - Country:US
Mailing Address - Phone:508-828-9116
Mailing Address - Fax:
Practice Address - Street 1:1 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:TAUNTON
Practice Address - State:MA
Practice Address - Zip Code:02780-3960
Practice Address - Country:US
Practice Address - Phone:508-828-9116
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-06
Last Update Date:2012-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical