MEDICARE: FRANCESCA 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
1	101YM0800X	Mental Health Counselor	012334-01	NY

General Provider Information

NPI Number	:	1750010377
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FRANCESCA RUSSO

Provider Business Mailing Address
First Line	:	1060 SENECA AVE
Second Line	:
City	:	RIDGEWOOD
State	:	NY
Zip	:	11385-5811
Country	:	US
Telephone Number	:	512-289-1378
Fax Number	:

Provider Business Practice Location Address
First Line	:	574 ATLANTIC AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11217-4954
Country	:	US
Telephone Number	:	512-289-1378
Fax Number	:

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

Provider Enumeration Date	:	06/08/2022
Last Update Date	:	06/08/2022

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Directions to “ FRANCESCA RUSSO ” Practice Location

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