Provider Demographics
NPI:1013085943
Name:RUSSO, PAULA K (LMHC)
Entity Type:Individual
Prefix:
First Name:PAULA
Middle Name:K
Last Name:RUSSO
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41 OAK ST.
Mailing Address - Street 2:
Mailing Address - City:DOUGLAS
Mailing Address - State:MA
Mailing Address - Zip Code:01516-2215
Mailing Address - Country:US
Mailing Address - Phone:978-250-1560
Mailing Address - Fax:508-476-3051
Practice Address - Street 1:41 OAK ST.
Practice Address - Street 2:
Practice Address - City:DOUGLAS
Practice Address - State:MA
Practice Address - Zip Code:01516-2215
Practice Address - Country:US
Practice Address - Phone:978-250-1560
Practice Address - Fax:508-476-3051
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA370101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health