| NPI | 1184064636 |
|---|---|
| Other Name | JILLIAN RUSSO-GOODWIN |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MA 10434) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| Enumeration Date | 2013-06-28 |
| Last Update Date | 2021-06-30 |