Healthcare Provider Details

I. General information

NPI: 1518177567
Provider Name (Legal Business Name): BARBARA ANN RUSSEK PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/22/2007
Last Update Date: 07/16/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 E END AVE 1B
NEW YORK NY
10028-7053
US

IV. Provider business mailing address

30 E END AVE 1B
NEW YORK NY
10028-7053
US

V. Phone/Fax

Practice location:
  • Phone: 212-737-8370
  • Fax: 212-737-6416
Mailing address:
  • Phone: 212-737-8370
  • Fax: 212-737-6416

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TA0700X
TaxonomyAdult Development & Aging Psychologist
License Number011617
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number011617
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number011617
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code103TF0000X
TaxonomyFamily Psychologist
License Number011617
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: