Individual
DIANA RUSSO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LAC
Contact information
Practice address
15 CALVIN PL, METUCHEN, NJ 08840-2450
(732) 549-0401
Mailing address
15 CALVIN PL, METUCHEN, NJ 08840-2450
(732) 549-0401
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Enumeration date
05/26/2022
Last updated
05/26/2022
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