MEDICARE: CHRISTINE RUSSO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor		MA

General Provider Information

NPI Number	:	1669347118
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTINE RUSSO

Provider Business Mailing Address
First Line	:	1401 BEACON ST APT 402
Second Line	:
City	:	BROOKLINE
State	:	MA
Zip	:	02446-4806
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	38 RESNIK RD STE 201
Second Line	:
City	:	PLYMOUTH
State	:	MA
Zip	:	02360-7214
Country	:	US
Telephone Number	:	508-209-7846
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/06/2025
Last Update Date	:	10/06/2025

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Directions to “ CHRISTINE RUSSO ” Practice Location

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