Provider Demographics
NPI:1649679648
Name:RUSSELL-BLIDGEN, PRINCESS (LCSW)
Entity type:Individual
Prefix:MRS
First Name:PRINCESS
Middle Name:
Last Name:RUSSELL-BLIDGEN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 S BARN HILL RD
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06002-1622
Mailing Address - Country:US
Mailing Address - Phone:860-890-3052
Mailing Address - Fax:
Practice Address - Street 1:6 S BARN HILL RD
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD
Practice Address - State:CT
Practice Address - Zip Code:06002-1622
Practice Address - Country:US
Practice Address - Phone:860-890-3052
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-15
Last Update Date:2024-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0099221041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical