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1235647314
NICOLE RUSSO
PHILADELPHIA, PA
NPI
1235647314
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
No
Primary Taxonomy
101YA0400X Counselor, Addiction (Substance Use Disorder)
Enumeration Date
2018-01-11
Last Update Date
2018-01-11
Business Address
NICOLE RUSSO
9815 ROOSEVELT BLVD
PHILADELPHIA, PA 19114-1035
Phone number: 616-644-6464
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Mailing Address
NICOLE RUSSO
680 AMERICAN AVE
KING OF PRUSSIA, PA 19406-4023
Phone number: 616-644-6464
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