Doctor Name: | MS. SUSAN K RUSSO |
NPI Number: | 1538292982 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | L.P.C.C. |
License Number: | 0088901 |
Business Practice Address: | 36 State Rd. 522 #6 El Prado, NM - 87529 |
Business Phone Number: | 5057379151 |
Business Fax Number: | 5057510846 |
Mailing Address: | Hc 74 Box 22615, EL PRADO |
State: | NM |
Postal Code: | 875299526 |
Phone Number: | 5057763826 |
Fax Number: | 5057510846 |
NPI Enumeration Date: | 03/14/2007 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | 0088901 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NM |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |