MEDICARE: DR. JENNIFER MARIE DEL RUSSO PSY.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	35SI00535200	NJ

General Provider Information

NPI Number	:	1720386279
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JENNIFER MARIE DEL RUSSO PSY.D.

Provider Business Mailing Address
First Line	:	342 HADDON AVE
Second Line	:	SUITE 201
City	:	HADDON TWP
State	:	NJ
Zip	:	08108-2861
Country	:	US
Telephone Number	:	856-298-1256
Fax Number	:	856-375-1322

Provider Business Practice Location Address
First Line	:	342 HADDON AVE
Second Line	:	SUITE 201
City	:	HADDON TWP
State	:	NJ
Zip	:	08108-2861
Country	:	US
Telephone Number	:	856-298-1256
Fax Number	:	856-375-1322

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/08/2011
Last Update Date	:	04/14/2025

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