Provider Demographics
NPI:1669534624
Name:RUSSELL, KRISTEN DONNA (LCSW)
Entity type:Individual
Prefix:MS
First Name:KRISTEN
Middle Name:DONNA
Last Name:RUSSELL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:KRISTEN
Other - Middle Name:DONNA
Other - Last Name:KOWALSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:500 VINE ST
Mailing Address - Street 2:CAPITOL REGION MENTAL HEALTH CENTER
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06112-1639
Mailing Address - Country:US
Mailing Address - Phone:860-293-6330
Mailing Address - Fax:860-297-0915
Practice Address - Street 1:500 VINE ST
Practice Address - Street 2:CAPITOL REGION MENTAL HEALTH CENTER
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06112-1639
Practice Address - Country:US
Practice Address - Phone:860-293-6330
Practice Address - Fax:860-297-0915
Is Sole Proprietor?:No
Enumeration Date:2006-12-15
Last Update Date:2016-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0062691041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical