Provider Demographics
NPI:1417014838
Name:RUSENKO, DEBRA J (LIC AC)
Entity Type:Individual
Prefix:MS
First Name:DEBRA
Middle Name:J
Last Name:RUSENKO
Suffix:
Gender:F
Credentials:LIC AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:132 BAY RD
Mailing Address - Street 2:
Mailing Address - City:HADLEY
Mailing Address - State:MA
Mailing Address - Zip Code:01035-9689
Mailing Address - Country:US
Mailing Address - Phone:413-695-5649
Mailing Address - Fax:
Practice Address - Street 1:8 GOFFE ST
Practice Address - Street 2:
Practice Address - City:HADLEY
Practice Address - State:MA
Practice Address - Zip Code:01035-9559
Practice Address - Country:US
Practice Address - Phone:413-954-2004
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2010-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA223613171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist