Provider Demographics
NPI:1154855351
Name:RUSSO, CATHERINE ANNE (MED, BCBA)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:ANNE
Last Name:RUSSO
Suffix:
Gender:F
Credentials:MED, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 BIGELOW ST
Mailing Address - Street 2:APARTMENT #1
Mailing Address - City:BRIGHTON
Mailing Address - State:MA
Mailing Address - Zip Code:02135-1622
Mailing Address - Country:US
Mailing Address - Phone:617-694-6403
Mailing Address - Fax:
Practice Address - Street 1:11 BIGELOW ST
Practice Address - Street 2:APARTMENT #1
Practice Address - City:BRIGHTON
Practice Address - State:MA
Practice Address - Zip Code:02135-1622
Practice Address - Country:US
Practice Address - Phone:617-694-6403
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-13
Last Update Date:2017-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst