Provider Demographics
NPI:1881075315
Name:RUSSELL, MOLLY ELIZABETH
Entity type:Individual
Prefix:MS
First Name:MOLLY
Middle Name:ELIZABETH
Last Name:RUSSELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 AUBURN ST
Mailing Address - Street 2:
Mailing Address - City:CHERRY VALLEY
Mailing Address - State:MA
Mailing Address - Zip Code:01611-3223
Mailing Address - Country:US
Mailing Address - Phone:508-523-5937
Mailing Address - Fax:
Practice Address - Street 1:115 AUBURN ST
Practice Address - Street 2:
Practice Address - City:CHERRY VALLEY
Practice Address - State:MA
Practice Address - Zip Code:01611-3223
Practice Address - Country:US
Practice Address - Phone:508-523-5937
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-10
Last Update Date:2015-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health