MEDICARE: ABBY RUSSIN, PH.D., LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist	PS016373	PA

General Provider Information

NPI Number	:	1699912691
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ABBY RUSSIN, PH.D., LLC

Provider Business Mailing Address
First Line	:	1516 WYOMING AVE
Second Line	:
City	:	FORTY FORT
State	:	PA
Zip	:	18704-4225
Country	:	US
Telephone Number	:	570-287-5200
Fax Number	:	570-609-1551

Provider Business Practice Location Address
First Line	:	1516 WYOMING AVE
Second Line	:
City	:	FORTY FORT
State	:	PA
Zip	:	18704-4225
Country	:	US
Telephone Number	:	570-287-5200
Fax Number	:	570-609-1551

Authorized Official
Title or Position	:	OWNER/PSYCHOLOGIST
Name	:	DR. ABBY RUSSIN
Credential	:	PH.D.
Telephone Number	:	570-287-5200

Provider Enumeration Date	:	01/13/2009
Last Update Date	:	09/02/2025

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