Individual
DEBORAH J. RUSSO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHD
Contact information
Practice address
905 JOHNS HOPKINS DR, ECU PHYSICIANS PSYCHIATRIC MEDICINE OUTPATIENT CENTER, GREENVILLE, NC 27834-7225
(252) 744-1406
(252) 744-2419
Mailing address
PO BOX 751069, ECU PHYSICIANS, CHARLOTTE, NC 28275-1069
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
3986
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
162G7
BCBSNC
NC
05
—
6001277
—
NC
Enumeration date
03/29/2007
Last updated
11/09/2011
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