Provider Demographics
NPI:1982940672
Name:RUSSO, NATALIE (PHD)
Entity Type:Individual
Prefix:DR
First Name:NATALIE
Middle Name:
Last Name:RUSSO
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:403 HUNTINGTON HL
Mailing Address - Street 2:SYRACUSE UNIVERSITY DEPT. OF PSYCHOLOGY
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13244-0001
Mailing Address - Country:US
Mailing Address - Phone:315-443-2024
Mailing Address - Fax:
Practice Address - Street 1:403 HUNTINGTON HL
Practice Address - Street 2:SYRACUSE UNIVERSITY DEPT. OF PSYCHOLOGY
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13244-0001
Practice Address - Country:US
Practice Address - Phone:315-443-2024
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-12-27
Last Update Date:2012-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool