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Individual

MICHAEL RUSSO

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man

Contact information

Practice address
2500 AVON BELDEN RD, GRAFTON, OH 44044-9802
(440) 748-5497
Mailing address
2500 AVON BELDEN RD, GRAFTON, OH 44044-9802
(440) 748-5497

Taxonomy

Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
4775
OH

Other

Enumeration date
09/16/2014
Last updated
09/16/2014
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