MEDICARE: DEANNA RUSSO AMFT

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	106H00000X	Marriage & Family Therapist		CA

General Provider Information

NPI Number	:	1720934342
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEANNA RUSSO AMFT

Provider Business Mailing Address
First Line	:	3108 GLENDALE BLVD # 224
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90039-1806
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	453 S SPRING ST # 1237
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90013-2013
Country	:	US
Telephone Number	:	323-552-7110
Fax Number	:

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

Provider Enumeration Date	:	03/06/2026
Last Update Date	:	03/06/2026

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