Individual
MRS. LAURA ANN RUSSO-INNAMORATO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PSYD
Contact information
Practice address
19 CAMPUS BLVD, STE 102 DELAWARE COUNTY PROFESSIONAL SERVICES, NEWTOWN SQUARE, PA 19073
(610) 356-2100
(610) 356-6645
Mailing address
1204 HOLLY LANE, GLEN MILLS, PA 19342
(610) 356-2100
(610) 356-6645
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
PS017407
PA
1041C0700X
Clinical Social Worker
CW013505
PA
Other
Enumeration date
10/03/2006
Last updated
10/19/2021
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