Individual
STEPHEN A. RUSSO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PH.D
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
103T00000X
Psychologist
Primary
PS015087
PA
103TE1100X
Exercise & Sports Psychologist
PS015087
PA
Other
Enumeration date
12/05/2008
Last updated
02/08/2020
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