Russo, Mary

Russo, Mary is an individual health care provider with primary practice located at 925 Route 73 N Ste H , Marlton NJ 08053-1277. She recently has only one registered license in Behavioral Health & Social Service Providers / Counselor, which is considered as her primary health care specialty. Russo, Mary can be contacted via phone (609) 713-8763.

Contact Information

Primary practice address
925 Route 73 N Ste H Marlton NJ 08053-1277
Fax:
Website:

Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Counselor 101Y00000X

Profile Details

NPI number 1639818388
LBN Legal business name Russo, Mary
Credentials
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 1st, 2022
Last updated Jun 1st, 2022 - about 4 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1639818388 NPPES
New Jersey Other R94585277161805 DRIVER LICENSE

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