Provider Demographics
NPI:1689719874
Name:HOLSTEIN, RUSSELL M (PHD)
Entity type:Individual
Prefix:DR
First Name:RUSSELL
Middle Name:M
Last Name:HOLSTEIN
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 1:170 MORRIS AVE
Mailing Address - Street 2:
Mailing Address - City:LONG BRANCH
Mailing Address - State:NJ
Mailing Address - Zip Code:07740-8214
Mailing Address - Country:US
Mailing Address - Phone:732-571-1200
Mailing Address - Fax:732-571-1100
Practice Address - Street 1:170 MORRIS AVE
Practice Address - Street 2:
Practice Address - City:LONG BRANCH
Practice Address - State:NJ
Practice Address - Zip Code:07740-8214
Practice Address - Country:US
Practice Address - Phone:732-571-1200
Practice Address - Fax:732-571-1100
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJSI00094100103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical