Provider Demographics
NPI:1770005845
Name:RUSSELL, MEGAN MARIE (PHD)
Entity type:Individual
Prefix:DR
First Name:MEGAN
Middle Name:MARIE
Last Name:RUSSELL
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:MEGAN
Other - Middle Name:MARIE
Other - Last Name:RUSSELL-CURRIE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:660 NEWTOWN YARDLEY RD STE 203
Mailing Address - Street 2:
Mailing Address - City:NEWTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18940-4011
Mailing Address - Country:US
Mailing Address - Phone:215-344-7342
Mailing Address - Fax:267-692-1732
Practice Address - Street 1:660 NEWTOWN YARDLEY RD STE 203
Practice Address - Street 2:
Practice Address - City:NEWTOWN
Practice Address - State:PA
Practice Address - Zip Code:18940-4011
Practice Address - Country:US
Practice Address - Phone:215-344-7342
Practice Address - Fax:267-692-1732
Is Sole Proprietor?:No
Enumeration Date:2017-07-11
Last Update Date:2024-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS016638103T00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist