Healthcare Provider Details

I. General information

NPI: 1720386279
Provider Name (Legal Business Name): JENNIFER MARIE DEL RUSSO PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/08/2011
Last Update Date: 04/14/2025
Certification Date: 04/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

342 HADDON AVE SUITE 201
HADDON TWP NJ
08108-2861
US

IV. Provider business mailing address

342 HADDON AVE SUITE 201
HADDON TWP NJ
08108-2861
US

V. Phone/Fax

Practice location:
  • Phone: 856-298-1256
  • Fax: 856-375-1322
Mailing address:
  • Phone: 856-298-1256
  • Fax: 856-375-1322

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number35SI00535200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: