Healthcare Provider Details

I. General information

NPI: 1497668446
Provider Name (Legal Business Name): ALISHA A RUSSO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/22/2026
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

173 HUGUENOT ST STE 200
NEW ROCHELLE NY
10801-7710
US

IV. Provider business mailing address

173 HUGUENOT ST STE 200
NEW ROCHELLE NY
10801-7710
US

V. Phone/Fax

Practice location:
  • Phone: 646-386-1527
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: