Individual
ERICA RUSSO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
321 FORTUNE BLVD, BEACON SERVICES, MILFORD, MA 02130
(339) 222-7868
Mailing address
39 SOUTH ST, KINGSTON, MA 02364-1812
Taxonomy
Speciality
Code
Description
License number
State
222Q00000X
Developmental Therapist
Primary
—
—
Other
Enumeration date
11/01/2016
Last updated
11/07/2016
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