Provider Demographics
NPI:1730236712
Name:RUSSO, BARBARA (LCSW)
Entity type:Individual
Prefix:
First Name:BARBARA
Middle Name:
Last Name:RUSSO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3895 COUNTY ROAD 516 STE 2B
Mailing Address - Street 2:
Mailing Address - City:OLD BRIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:08857-2499
Mailing Address - Country:US
Mailing Address - Phone:732-679-4500
Mailing Address - Fax:732-679-4549
Practice Address - Street 1:3895 COUNTY ROAD 516 STE 2B
Practice Address - Street 2:
Practice Address - City:OLD BRIDGE
Practice Address - State:NJ
Practice Address - Zip Code:08857-2499
Practice Address - Country:US
Practice Address - Phone:732-679-4500
Practice Address - Fax:732-679-4549
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-04
Last Update Date:2008-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC047684001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical