Individual
MS. SUSAN K RUSSO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
L.P.C.C.
Contact information
Practice address
36 STATE RD. 522, #6, EL PRADO, NM 87529
(505) 737-9151
(505) 751-0846
Mailing address
HC 74 BOX 22615, EL PRADO, NM 87529-9526
(505) 776-3826
(505) 751-0846
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
0088901
NM
Other
Enumeration date
03/14/2007
Last updated
07/08/2007
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