Doctor Name: | MRS. LAURA ANN RUSSO-INNAMORATO |
NPI Number: | 1003900044 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | CSW |
License Number: | CW013505 |
Business Practice Address: | 19 Campus Blvd Ste 102 Delaware County Professional Services Newtown Square, PA - 19073 |
Business Phone Number: | 6103562100 |
Business Fax Number: | 6103566645 |
Mailing Address: | 1204 Holly Lane, GLEN MILLS |
State: | PA |
Postal Code: | 19342 |
Phone Number: | 6103562100 |
Fax Number: | 6103566645 |
NPI Enumeration Date: | 10/03/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 1041C0700X |
License Number: | CW013505 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | PA |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Social Worker |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: | A social worker who holds a master |