Basic Information
| Provider Information | |||||||||
| NPI: | 1467798678 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RUSSELL | ||||||||
| FirstName: | CORTNEY | ||||||||
| MiddleName: | MICHELLE | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | MSW, CSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2117 ICHLAND AVENUE | ||||||||
| Address2: | APARTMENT 34 | ||||||||
| City: | METAIRIE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 70001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5042227591 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2626 CHARLES DR | ||||||||
| Address2: | |||||||||
| City: | CHALMETTE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 700433779 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5042784006 | ||||||||
| FaxNumber: | 5042784007 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/14/2012 | ||||||||
| LastUpdateDate: | 12/14/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.