Organization
PHILADELPHIA CONCUSSION SPECIALISTS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
STEPHEN A RUSSO PHD (FOUNDER & CLINICAL DIRECTOR)
(484) 818-2225
Entity
Organization
Contact information
Practice address
3300 TOWNSHIP LINE RD, DREXEL HILL, PA 19026-1925
(484) 818-2225
(866) 818-4032
Mailing address
PO BOX 741, MEDIA, PA 19063-0741
(484) 818-2225
(866) 818-4032
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
—
—
Other
Enumeration date
10/21/2019
Last updated
02/08/2020
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