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General NPI Number Information
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NPI Number | 1699912691
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Entity Type | Organization
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Legal Business Name | ABBY RUSSIN, PH.D., LLC
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Dates
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Enumeration Date | 01/13/2009
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Last Update Date | 09/02/2025
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Provider Practice Location Address
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Address Line | 1516 WYOMING AVE
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City | FORTY FORT
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State | PA
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Zip | 18704-4225
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Country | US
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Telephone | 570-287-5200
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Fax | 570-609-1551
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Provider Business Mailing Address
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Address Line | 1516 WYOMING AVE
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City | FORTY FORT
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State | PA
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Zip | 18704-4225
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Country | US
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Telephone | 570-287-5200
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Fax | 570-609-1551
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Authorized Official
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Title or Position | OWNER/PSYCHOLOGIST
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Name | DR. ABBY RUSSIN
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Credential | PH.D.
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Telephone | 570-287-5200
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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 | PS016373
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License Number State | PA
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