Provider Demographics
NPI:1841943909
Name:RUSSELL ANTHONY MARTIN PSYCHOTHERAPY LCSW PC
Entity type:Organization
Organization Name:RUSSELL ANTHONY MARTIN PSYCHOTHERAPY LCSW PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOTHERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:RUSSELL
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW-R
Authorized Official - Phone:646-251-7869
Mailing Address - Street 1:29 MOUNTAIN TRL
Mailing Address - Street 2:
Mailing Address - City:CROTON ON HUDSON
Mailing Address - State:NY
Mailing Address - Zip Code:10520-2209
Mailing Address - Country:US
Mailing Address - Phone:646-251-7869
Mailing Address - Fax:
Practice Address - Street 1:11 BROADWAY STE 1158
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10004-1597
Practice Address - Country:US
Practice Address - Phone:646-251-7869
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-30
Last Update Date:2022-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1588055313OtherNPI