Provider Demographics
NPI:1861642787
Name:GRACE RUSSO, INC.
Entity Type:Organization
Organization Name:GRACE RUSSO, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:GRACE
Authorized Official - Middle Name:
Authorized Official - Last Name:RUSSO
Authorized Official - Suffix:
Authorized Official - Credentials:MS, ED
Authorized Official - Phone:914-443-0138
Mailing Address - Street 1:43 CONESTOGA TRL
Mailing Address - Street 2:
Mailing Address - City:SPARTA
Mailing Address - State:NJ
Mailing Address - Zip Code:07871-2509
Mailing Address - Country:US
Mailing Address - Phone:973-726-7786
Mailing Address - Fax:973-726-7786
Practice Address - Street 1:43 CONESTOGA TRL
Practice Address - Street 2:
Practice Address - City:SPARTA
Practice Address - State:NJ
Practice Address - Zip Code:07871-2509
Practice Address - Country:US
Practice Address - Phone:973-726-7786
Practice Address - Fax:973-726-7786
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-28
Last Update Date:2008-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency