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NPI Code Detail

MEDICARE: GENA RUSSO

MEDICARE: GENA 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
1251S00000XCommunity/Behavioral Health Agency1957CO

General Provider Information

NPI Number : 1205109667
Entity Type Code : Organization
Provider Name (Legal Business Name) : GENA RUSSO
Provider Business Mailing Address
First Line : 2984 S WABASH ST
Second Line :
City : DENVER
State : CO
Zip : 80231-4223
Country : US
Telephone Number : 860-874-7149
Fax Number :
Provider Business Practice Location Address
First Line : 2984 S WABASH ST
Second Line :
City : DENVER
State : CO
Zip : 80231-4223
Country : US
Telephone Number : 860-874-7149
Fax Number :
Authorized Official
Title or Position : LICSENSED CLINICAL SOCIAL WORKER
Name : GENA HOPE RUSSO
Credential : LCSW
Telephone Number : 860-874-7149
Provider Enumeration Date : 02/15/2012
Last Update Date : 02/15/2012

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Directions to “GENA RUSSO ” Practice Location

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