Individual
DR. JESSICA DEAN RUSSO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PSY.D.
Contact information
Practice address
230 S. BROAD ST., STE 600, PHILA, PA 19102-4121
(215) 545-2748
(215) 545-2749
Mailing address
230 S. BROAD ST., STE 600, PHILA, PA 19102-4121
(215) 545-2748
(215) 545-2749
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
PS015317
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1522333
BC/BS
PA
01
—
1522333
BLUE CROSS BLUE SHIELD
—
Enumeration date
03/06/2007
Last updated
02/24/2010
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