Provider Demographics
NPI:1720386279
Name:DELRUSSO, JENNIFER MARIE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:MARIE
Last Name:DELRUSSO
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:342 HADDON AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:HADDON TWP
Mailing Address - State:NJ
Mailing Address - Zip Code:08108-2861
Mailing Address - Country:US
Mailing Address - Phone:856-298-1256
Mailing Address - Fax:856-375-1322
Practice Address - Street 1:342 HADDON AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:HADDON TWP
Practice Address - State:NJ
Practice Address - Zip Code:08108-2861
Practice Address - Country:US
Practice Address - Phone:856-298-1256
Practice Address - Fax:856-375-1322
Is Sole Proprietor?:No
Enumeration Date:2011-03-08
Last Update Date:2023-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00356400101YP2500X
NJ35SI00535200103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional