Individual
PAUL LAWRENCE RUSSOMANNO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LAC
Contact information
Practice address
1 LUPTON AVE, WOODBURY, NJ 08096-5901
(973) 886-9213
Mailing address
1 LUPTON AVE, WOODBURY, NJ 08096-5901
(856) 693-5775
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
37AC00533900
NJ
101YP2500X
Professional Counselor
Primary
37PC01155000
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0995711
—
NJ
Enumeration date
10/24/2022
Last updated
06/30/2025
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