Provider Demographics
NPI:1730634775
Name:RUSSO, HELANA M (LPC,LCADC)
Entity Type:Individual
Prefix:
First Name:HELANA
Middle Name:M
Last Name:RUSSO
Suffix:
Gender:F
Credentials:LPC,LCADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36 DAVIS RD
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:NJ
Mailing Address - Zip Code:08079
Mailing Address - Country:US
Mailing Address - Phone:609-365-0909
Mailing Address - Fax:
Practice Address - Street 1:616 SEABREEZE AVE
Practice Address - Street 2:
Practice Address - City:EGG HARBOR TWP
Practice Address - State:NJ
Practice Address - Zip Code:08234-9674
Practice Address - Country:US
Practice Address - Phone:609-365-0909
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-19
Last Update Date:2021-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37LC00241600101YA0400X
NJ37LP00747500101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)