Individual
ANDRES RUSSO SR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
12 SCHOOL ST, LAWRENCE, MA 01841-5042
(978) 382-0522
Mailing address
12 SCHOOL ST, LAWRENCE, MA 01841-5042
(978) 382-0522
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
251S00000X
Community/Behavioral Health Agency
Primary
—
MA
Other
Enumeration date
08/18/2015
Last updated
08/18/2015
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