Individual
DR. JACQUELINE RUSSO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PSYD
Contact information
Practice address
351 MANVILLE RD STE 104, PLEASANTVILLE, NY 10570-2166
(413) 384-9240
Mailing address
3083 23RD ST APT 2A, ASTORIA, NY 11102-3325
(516) 317-1876
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
022242-1
NY
Other
Enumeration date
10/28/2018
Last updated
10/28/2018
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