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NPI Code Detail

MEDICARE: ANNIE L RUSSO LCSW, LCADC

MEDICARE: ANNIE L RUSSO LCSW, LCADC
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
11041C0700XClinical Social Worker44SC05767600NJ

General Provider Information

NPI Number : 1023586146
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANNIE L RUSSO LCSW, LCADC
Provider Business Mailing Address
First Line : 24 LANDSDOWN RD
Second Line :
City : ANNANDALE
State : NJ
Zip : 08801-3603
Country : US
Telephone Number : 173-225-9096
Fax Number :
Provider Business Practice Location Address
First Line : 221 RIVER ST
Second Line :
City : HOBOKEN
State : NJ
Zip : 07030-5989
Country : US
Telephone Number : 646-941-7645
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/06/2018
Last Update Date : 01/10/2025

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