Individual
DIANE RUSSO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CASAC
Contact information
Practice address
281 PHELPS LN, NORTH BABYLON, NY 11703-4005
(631) 422-7676
Mailing address
894 WALNUT AVE, BOHEMIA, NY 11716-4228
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0009943
OASAS CASAC
NY
Enumeration date
12/17/2019
Last updated
11/27/2023
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