Individual
TANAESZA CYAN RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
77 W BALTIMORE PIKE STE 100B, MEDIA, PA 19063-5639
(610) 572-5520
(610) 527-5521
Mailing address
77 W BALTIMORE PIKE STE 100B, MEDIA, PA 19063-5639
(610) 572-5520
(610) 572-5521
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
BH006264
PA
106S00000X
Behavior Technician
—
—
Other
Enumeration date
12/16/2019
Last updated
01/03/2023
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