Most Relevant Information
Provider Data
| NPI Number: | 1003050683 |
| Provider Name: | MARC RICHARD RUSSAK LCSW |
| Entity Type: | Individual |
| Taxonomy Code: | 1041C0700X |
| Specialty: | Social Worker |
| License Number: | 25489 |
Most Important Dates
| Enumeration Date: | 04/27/2009 |
| Last Updated: | 04/27/2009 |
Provider Practice Location
1081 WESTWOOD BLVD STE 221
LOS ANGELES
CA
900242925
Practice Location Phone/Fax
| Phone: | 3108003986 |
| Fax: |
Provider Mailing Location
1081 WESTWOOD BLVD STE 221
LOS ANGELES
CA
900242925
Provider Mailing Phone/Fax
| Phone: | 3108003986 |
| Fax: |