Individual
STACEY RUSSO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
345A GREENWOOD ST, WORCESTER, MA 01607-1753
(508) 363-0200
Mailing address
345A GREENWOOD ST, WORCESTER, MA 01607-1753
(508) 363-0200
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
—
—
106S00000X
Behavior Technician
—
—
Other
Enumeration date
09/08/2021
Last updated
01/27/2022
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