Provider Demographics
NPI:1104188762
Name:KAREN RUSSO PHD LLC
Entity Type:Organization
Organization Name:KAREN RUSSO PHD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:RUSSO
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:302-738-3140
Mailing Address - Street 1:500 CREEK VIEW RD
Mailing Address - Street 2:SUITE 109
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19711-8549
Mailing Address - Country:US
Mailing Address - Phone:302-738-3140
Mailing Address - Fax:302-454-8026
Practice Address - Street 1:500 CREEK VIEW RD
Practice Address - Street 2:SUITE 109
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19711-8549
Practice Address - Country:US
Practice Address - Phone:302-738-3140
Practice Address - Fax:302-454-8026
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-11
Last Update Date:2015-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEB1-0000259103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty