Healthcare Provider Details

I. General information

NPI: 1902350713
Provider Name (Legal Business Name): LAUREN MARIE RUSSO MCCHESNEY MFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LAUREN RUSSO

II. Dates (important events)

Enumeration Date: 08/09/2016
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1410 MARSHALL ST
REDWOOD CITY CA
94063-2503
US

IV. Provider business mailing address

1410 MARSHALL ST
REDWOOD CITY CA
94063-2503
US

V. Phone/Fax

Practice location:
  • Phone: 925-785-4422
  • Fax:
Mailing address:
  • Phone: 925-785-4422
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number119703
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: