Individual
MARIA THERESA RUSSO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PH.D.
Contact information
Practice address
7 WILDFLOWER LANE, EAST HAMPTON, NY 11937-0254
(631) 329-3185
(631) 907-0726
Mailing address
PO BOX 4062, EAST HAMPTON, NY 11937-0254
(631) 329-3185
(631) 907-0726
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
010078
NY
Other
Enumeration date
03/05/2007
Last updated
07/08/2007
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