Healthcare Provider Details

I. General information

NPI: 1720934342
Provider Name (Legal Business Name): DEANNA RUSSO AMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/06/2026
Last Update Date: 03/06/2026
Certification Date: 03/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

453 S SPRING ST # 1237
LOS ANGELES CA
90013-2013
US

IV. Provider business mailing address

3108 GLENDALE BLVD # 224
LOS ANGELES CA
90039-1806
US

V. Phone/Fax

Practice location:
  • Phone: 323-552-7110
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: