Most Relevant Information
Provider Data
| NPI Number: | 1003350588 |
| Provider Name: | GINA RUSSELL |
| Entity Type: | Individual |
| Taxonomy Code: | 103K00000X |
| Specialty: | Behavior Analyst |
| License Number: |
Most Important Dates
| Enumeration Date: | 12/19/2016 |
| Last Updated: | 12/19/2016 |
Provider Practice Location
200 GRIFFIN RD STE 5
PORTSMOUTH
NH
038017145
Practice Location Phone/Fax
| Phone: | 8007785560 |
| Fax: |
Provider Mailing Location
200 GRIFFIN RD STE 5
PORTSMOUTH
NH
038017145
Provider Mailing Phone/Fax
| Phone: | 8007785560 |
| Fax: |