Provider Demographics
NPI:1699912691
Name:ABBY RUSSIN, PH.D., LLC
Entity type:Organization
Organization Name:ABBY RUSSIN, PH.D., LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ABBY
Authorized Official - Middle Name:
Authorized Official - Last Name:RUSSIN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:570-287-5200
Mailing Address - Street 1:1516 WYOMING AVE
Mailing Address - Street 2:
Mailing Address - City:FORTY FORT
Mailing Address - State:PA
Mailing Address - Zip Code:18704-4225
Mailing Address - Country:US
Mailing Address - Phone:570-287-5200
Mailing Address - Fax:570-609-1551
Practice Address - Street 1:1516 WYOMING AVE
Practice Address - Street 2:
Practice Address - City:FORTY FORT
Practice Address - State:PA
Practice Address - Zip Code:18704-4225
Practice Address - Country:US
Practice Address - Phone:570-287-5200
Practice Address - Fax:570-609-1551
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-13
Last Update Date:2024-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS016373103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty