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General NPI Number Information
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NPI Number | 1043616923
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Entity Type | Individual
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Provider Name | MARNI RUSSO PSYD, NCSP
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Gender | Female
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Dates
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Enumeration Date | 11/05/2014
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Last Update Date | 09/15/2022
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Provider Practice Location Address
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Address Line | 185 MADISON AVE FL 14
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City | NEW YORK
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State | NY
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Zip | 10016-4325
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Country | US
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Telephone | 212-506-5935
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Fax |
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Provider Business Mailing Address
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Address Line | 303 5TH AVE RM 502
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City | NEW YORK
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State | NY
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Zip | 10016-6644
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Country | US
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Telephone | 917-791-0525
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 024661
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License Number State | NY
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