Provider Demographics
NPI:1669785234
Name:RUSS, LEONARD (MSW)
Entity type:Individual
Prefix:MR
First Name:LEONARD
Middle Name:
Last Name:RUSS
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 ADAMS ST
Mailing Address - Street 2:208
Mailing Address - City:MALDEN
Mailing Address - State:MA
Mailing Address - Zip Code:02148-6451
Mailing Address - Country:US
Mailing Address - Phone:781-397-8588
Mailing Address - Fax:
Practice Address - Street 1:389 MAIN ST
Practice Address - Street 2:303
Practice Address - City:MALDEN
Practice Address - State:MA
Practice Address - Zip Code:02148-5017
Practice Address - Country:US
Practice Address - Phone:781-324-2381
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-23
Last Update Date:2010-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical