MEDICARE: MS. ROBIN RUSSO LCSW

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	1041C0700X	Clinical Social Worker	5842	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	5842	OTHER	FL	LCSW

General Provider Information

NPI Number	:	1043427917
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ROBIN RUSSO LCSW

Provider Business Mailing Address
First Line	:	4200 S CONGRESS AVE # MS 54
Second Line	:
City	:	LAKE WORTH
State	:	FL
Zip	:	33461-4705
Country	:	US
Telephone Number	:	561-301-1408
Fax Number	:	561-586-4474

Provider Business Practice Location Address
First Line	:	4200 S CONGRESS AVE # MS 54
Second Line	:
City	:	LAKE WORTH
State	:	FL
Zip	:	33461-4705
Country	:	US
Telephone Number	:	561-301-1408
Fax Number	:

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

Provider Enumeration Date	:	05/17/2007
Last Update Date	:	07/18/2024

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