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Individual

ROBERT RUSSO JR.

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
PC

Contact information

Practice address
311 DORIC AVE, CRANSTON, RI 02910-2903
(401) 784-3600
(401) 783-3636
Mailing address
311 DORIC AVE, CRANSTON, RI 02910-2903
(401) 784-3600
(401) 783-3636

Taxonomy

Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
GH57134
RI
Enumeration date
09/29/2008
Last updated
09/29/2008
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