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General NPI Number Information
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NPI Number | 1962997155
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Entity Type | Individual
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Provider Name | STEPHANY LO RUSSO MS.ED, BCBA
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Gender | Female
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Dates
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Enumeration Date | 06/29/2018
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Last Update Date | 02/27/2019
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Provider Practice Location Address
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Address Line | MANHATTAN BEHAVIORAL CENTER 124 W 95TH STREET
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City | NEW YORK
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State | NY
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Zip | 10025
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Country | US
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Telephone | 646-480-5756
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Fax |
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Provider Business Mailing Address
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Address Line | 1492 BELLMORE RD
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City | NORTH BELLMORE
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State | NY
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Zip | 11710-3713
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Country | US
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Telephone | 516-348-4487
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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 | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 1-18-29784
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License Number State | NY
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