Individual
GRACE RUSSO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
43 CONESTOGA TRL, SPARTA, NJ 07871-2509
(914) 443-0138
Mailing address
43 CONESTOGA TRL, SPARTA, NJ 07871-2509
(914) 443-0138
Taxonomy
Speciality
Code
Description
License number
State
252Y00000X
Early Intervention Provider Agency
Primary
—
NY
Other
Enumeration date
09/28/2008
Last updated
09/28/2008
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