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NPI Code Detail

MEDICARE: CARRIE ANNE RUSSO

MEDICARE: CARRIE ANNE RUSSO
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
1101YM0800XMental Health CounselorFL

General Provider Information

NPI Number : 1093657892
Entity Type Code : Individual
Provider Name (Legal Business Name) : CARRIE ANNE RUSSO
Provider Business Mailing Address
First Line : 1181 PALO ALTO ST SE
Second Line :
City : PALM BAY
State : FL
Zip : 32909-7208
Country : US
Telephone Number : 401-602-8412
Fax Number :
Provider Business Practice Location Address
First Line : 630 S WICKHAM RD STE 107
Second Line :
City : WEST MELBOURNE
State : FL
Zip : 32904-1429
Country : US
Telephone Number : 321-608-0604
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/08/2026
Last Update Date : 04/08/2026

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