Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TS0200X | School Psychologist | 114276 | NH |
NPI | 1023617073 |
---|---|
Provider Name | Emily Catherine Russell |
First Address | Littleton, NH 03561-4137 |
Second Address | Lisbon, NH 03585-6112 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/10/2020 |
Last Update Date | 21/10/2020 |