Benjaminrussack
Organization Active NPI Community/Behavioral Health Agency · Mill Valley, CA
NPI 1083014773 · NPPES record last updated Aug 29, 2014
Key facts
- NPI
- 1083014773
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community/Behavioral Health Agency 251S00000X
- License
- 78602 (CA)
- Legal business name
- BENJAMINRUSSACK
- Practice address
- 20 Shelley Dr Apt 6
Mill Valley, CA 94941-1562 - Phone
- (415) 497-1908
- NPI assigned
- Aug 29, 2014
- Organization subpart
- No
Authorized official
- Name
- Mr. Benjamin D Russack
- Title
- MFT
- Phone
- (415) 497-1908
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community/Behavioral Health Agency | 251S00000X | 78602 | CA | Yes |
Addresses
Primary practice location
20 Shelley Dr Apt 6
Mill Valley, CA 94941-1562
Mailing address
20 Shelley Dr Apt 6
Mill Valley, CA 94941-1562
Phone (415) 497-1908
Other providers in Mill Valley, CA
- Alletta Christenson Bayer
- Erynn Anne Beeson
- Robert E Belknap
- Monica Beltrami
- Lauren Emily Bence
- Brooke E Bennis
- Tina Marie Benson
- Claire Atterbury Bernard Miller
- Ann Bernhardt
- Eve Bernstein
All providers in Mill Valley, CA · Community/Behavioral Health Agency in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 29, 2014. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.