Individual
DR. MARCY L. RUSSO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PH.D.
Contact information
Practice address
200 RETREAT AVENUE, HARTFORD HOSPITAL PSYCHIATRY DEPT, HARTFORD, CT 06106-3309
(860) 545-7410
Mailing address
200 RETREAT AVE, HARTFORD HOSPITAL PSYCHIATRY DEPT, HARTFORD, CT 06106-3309
(860) 545-7410
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
002459
CT
103TC0700X
Clinical Psychologist
Primary
002452
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
008037436
—
CT
Enumeration date
11/18/2008
Last updated
11/30/2021
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