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General NPI Number Information
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NPI Number | 1902108277
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Entity Type | Individual
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Provider Name | RACHELLE A. B. RUSSO LCSW, CSAC
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Gender | Female
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Dates
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Enumeration Date | 11/18/2010
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Last Update Date | 11/18/2010
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Provider Practice Location Address
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Address Line | 606 CORAL ST FL 3
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City | HONOLULU
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State | HI
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Zip | 96813-5135
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Country | US
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Telephone | 808-282-8312
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Fax |
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Provider Business Mailing Address
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Address Line | 606 CORAL ST FL 2
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City | HONOLULU
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State | HI
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Zip | 96813-5135
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Country | US
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Telephone | 808-282-8312
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 1312-06
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License Number State | HI
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 3686
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License Number State | HI
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