Individual
JENNIFER LYNN RUSSO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPC, LCADC, ACS
Contact information
Practice address
13 STILLWATER RD, BLAIRSTOWN, NJ 07825-9554
(908) 310-4323
Mailing address
13 STILLWATER RD, BLAIRSTOWN, NJ 07825-9554
(908) 310-4323
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
37LC00239900
NJ
101YM0800X
Mental Health Counselor
Primary
37PC00571300
NJ
Other
Enumeration date
03/22/2016
Last updated
04/24/2019
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