Provider Demographics
NPI:1679183263
Name:KERRI RUSSELL-RUSSO, LCSW & ASSOCIATES PSYCHOTHERAPY SERVICES, LLC
Entity Type:Organization
Organization Name:KERRI RUSSELL-RUSSO, LCSW & ASSOCIATES PSYCHOTHERAPY SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LCSW/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KERRI
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:RUSSO
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:908-433-7419
Mailing Address - Street 1:121 OAK GLEN RD
Mailing Address - Street 2:
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08753-3478
Mailing Address - Country:US
Mailing Address - Phone:908-433-7419
Mailing Address - Fax:
Practice Address - Street 1:35 BEAVERSON BLVD STE 4D
Practice Address - Street 2:
Practice Address - City:BRICK
Practice Address - State:NJ
Practice Address - Zip Code:08723-7857
Practice Address - Country:US
Practice Address - Phone:732-477-1980
Practice Address - Fax:732-477-4163
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-07
Last Update Date:2020-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty