Provider Demographics
NPI:1144505769
Name:RUSSO, DARLENE (MSCFY)
Entity type:Individual
Prefix:MRS
First Name:DARLENE
Middle Name:
Last Name:RUSSO
Suffix:
Gender:F
Credentials:MSCFY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2040 HENDRICKS AVE
Mailing Address - Street 2:
Mailing Address - City:BELLMORE
Mailing Address - State:NY
Mailing Address - Zip Code:11710-3009
Mailing Address - Country:US
Mailing Address - Phone:516-221-1555
Mailing Address - Fax:
Practice Address - Street 1:10 LAKE DR
Practice Address - Street 2:
Practice Address - City:MANHASSET HILLS
Practice Address - State:NY
Practice Address - Zip Code:11040-1123
Practice Address - Country:US
Practice Address - Phone:516-627-6391
Practice Address - Fax:516-627-2057
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-14
Last Update Date:2011-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist