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General NPI Number Information
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NPI Number | 1093657892
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Entity Type | Individual
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Provider Name | CARRIE ANNE RUSSO
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Gender | Female
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Dates
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Enumeration Date | 04/08/2026
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Last Update Date | 04/08/2026
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Provider Practice Location Address
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Address Line | 630 S WICKHAM RD STE 107
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City | WEST MELBOURNE
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State | FL
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Zip | 32904-1429
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Country | US
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Telephone | 321-608-0604
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Fax |
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Provider Business Mailing Address
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Address Line | 1181 PALO ALTO ST SE
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City | PALM BAY
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State | FL
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Zip | 32909-7208
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Country | US
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Telephone | 401-602-8412
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State | FL
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