Provider Demographics
NPI:1447134259
Name:RUSSO, ALISON (LAC)
Entity type:Individual
Prefix:
First Name:ALISON
Middle Name:
Last Name:RUSSO
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 OLD PALISADE RD APT 2910
Mailing Address - Street 2:
Mailing Address - City:FORT LEE
Mailing Address - State:NJ
Mailing Address - Zip Code:07024-7023
Mailing Address - Country:US
Mailing Address - Phone:201-482-4553
Mailing Address - Fax:201-482-4553
Practice Address - Street 1:100 OLD PALISADE RD APT 2910
Practice Address - Street 2:
Practice Address - City:FORT LEE
Practice Address - State:NJ
Practice Address - Zip Code:07024-7023
Practice Address - Country:US
Practice Address - Phone:201-482-4553
Practice Address - Fax:201-482-4553
Is Sole Proprietor?:No
Enumeration Date:2025-08-04
Last Update Date:2025-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37AC00838800103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling