Individual
MS. DEIRDRE LEE RUSSO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MFT
Contact information
Practice address
100 S JERSEY AVE, SUITE 42, EAST SETAUKET, NY 11733-2034
(631) 689-1728
Mailing address
8 WINMAR LN, SAYVILLE, NY 11782-1371
(631) 404-6431
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
Primary
P97555
NY
Other
Enumeration date
10/16/2015
Last updated
10/16/2015
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