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
Phone: (609) 713-8763
Fax:
Website:
Health care specialties
| Specialty | Code | License # | 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1639818388 | NPPES |
| New Jersey | Other | R94585277161805 | DRIVER LICENSE |
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