Provider Demographics
NPI:1083493886
Name:RUSSELL, MARIA D
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:D
Last Name:RUSSELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 S SUNNYSIDE RD
Mailing Address - Street 2:
Mailing Address - City:HIBERNIA
Mailing Address - State:NJ
Mailing Address - Zip Code:07842-1007
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1119 RARITAN AVE
Practice Address - Street 2:
Practice Address - City:HIGHLAND PARK
Practice Address - State:NJ
Practice Address - Zip Code:08904-3669
Practice Address - Country:US
Practice Address - Phone:732-380-5222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-21
Last Update Date:2023-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst