Organization
MIND AND BODY WELLNESS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. DEIRDRE LEE RUSSO LMFT (OWNER)
(631) 404-6431
Entity
Organization
Contact information
Practice address
1300 MONTAUK HWY, OAKDALE, NY 11769-1339
(631) 404-6431
Mailing address
1300 MONTAUK HWY, OAKDALE, NY 11769-1339
(631) 404-6431
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
Primary
—
—
Other
Enumeration date
07/19/2023
Last updated
07/19/2023
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