Provider Demographics
NPI:1447834569
Name:MARKS, RUSSELL MORGAN (PHD)
Entity type:Individual
Prefix:DR
First Name:RUSSELL
Middle Name:MORGAN
Last Name:MARKS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:427 WINTHROP ST UNIT 2
Mailing Address - Street 2:
Mailing Address - City:TAUNTON
Mailing Address - State:MA
Mailing Address - Zip Code:02780-6721
Mailing Address - Country:US
Mailing Address - Phone:508-331-3846
Mailing Address - Fax:
Practice Address - Street 1:110 LOCKWOOD STREET
Practice Address - Street 2:POTTER BUILDING
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02903
Practice Address - Country:US
Practice Address - Phone:401-444-2128
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-06
Last Update Date:2021-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103T00000X
RIPS01961103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist