Individual
LOUIS RUSSO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RN
Contact information
Practice address
224 MAIN ST, GOSHEN, NY 10924-2157
(845) 294-5888
Mailing address
224 MAIN ST, GOSHEN, NY 10924-2157
(845) 294-5888
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
409013
NY
Other
Enumeration date
04/25/2011
Last updated
04/25/2011
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