Provider Demographics
NPI:1831384759
Name:RUSSO, LINDA (BA)
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:
Last Name:RUSSO
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:LINDA
Other - Middle Name:
Other - Last Name:FROST
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:370 9TH ST
Mailing Address - Street 2:
Mailing Address - City:CRESCENT CITY
Mailing Address - State:CA
Mailing Address - Zip Code:95531-3432
Mailing Address - Country:US
Mailing Address - Phone:707-464-4349
Mailing Address - Fax:707-464-4572
Practice Address - Street 1:370 9TH ST
Practice Address - Street 2:
Practice Address - City:CRESCENT CITY
Practice Address - State:CA
Practice Address - Zip Code:95531-3432
Practice Address - Country:US
Practice Address - Phone:707-464-4349
Practice Address - Fax:707-464-4572
Is Sole Proprietor?:No
Enumeration Date:2007-09-13
Last Update Date:2007-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical