BENJAMIN DAVID RUSSACK

SAN RAFAEL, CA
NPI1801290770
Entity TypeIndividual
GenderMale
Sole Proprietor ?Yes
Primary Taxonomy106H00000X Marriage & Family Therapist
(Licence: CA  78602)
Enumeration Date2014-10-21
Last Update Date2014-10-21
Business Address
Mr. BENJAMIN DAVID RUSSACK MFT
711 FOURTH STREET 201
SAN RAFAEL, CA 94901
Phone number: 415-497-1908
Mailing Address
Mr. BENJAMIN DAVID RUSSACK MFT
711 FOURTH STREET 201
SAN RAFAEL, CA 94901
Phone number: 415-497-1908
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