Provider Demographics
NPI:1114334851
Name:RUSSO, DANIELLE M (PSYD)
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:M
Last Name:RUSSO
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 DAKIN AVE STE 110
Mailing Address - Street 2:
Mailing Address - City:MOUNT KISCO
Mailing Address - State:NY
Mailing Address - Zip Code:10549-2826
Mailing Address - Country:US
Mailing Address - Phone:516-225-8767
Mailing Address - Fax:
Practice Address - Street 1:16 DAKIN AVE STE 110
Practice Address - Street 2:
Practice Address - City:MOUNT KISCO
Practice Address - State:NY
Practice Address - Zip Code:10549-2826
Practice Address - Country:US
Practice Address - Phone:516-225-8767
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-15
Last Update Date:2025-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103T00000X
NY024364103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY203368734OtherPLACE OF EMPLOYMENT