Provider Demographics
NPI:1447081765
Name:RUSSELL AXEL, SEENA ANN (PSYCHOTHERAPIST)
Entity type:Individual
Prefix:
First Name:SEENA
Middle Name:ANN
Last Name:RUSSELL AXEL
Suffix:
Gender:F
Credentials:PSYCHOTHERAPIST
Other - Prefix:
Other - First Name:SEENA
Other - Middle Name:A
Other - Last Name:RUSSELL AXEL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:2845 NW 15TH ST
Mailing Address - Street 2:
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33445-7658
Mailing Address - Country:US
Mailing Address - Phone:516-443-4659
Mailing Address - Fax:
Practice Address - Street 1:2845 NW 15TH ST
Practice Address - Street 2:
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33445-7658
Practice Address - Country:US
Practice Address - Phone:516-443-4659
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-08
Last Update Date:2024-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000260103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral