DR. KELLY L RUSSO (NPI# 1265664734) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1265664734 |
| Entity Type | Individual |
| Full Name | DR. KELLY L RUSSO |
| Other Name | KELLY L DAVIS |
| Credential | PH.D. |
| Practice Address |
1767 Village Park Dr Orangeburg SC 29118-2475 |
| Mailing Address |
715 Darlington St Columbia SC 29201-1201 |
| Practice Telephone | 8037764000 |
| Practice Fax Number | 8035361719 |
| Mailing Telephone | 2393148511 |
| Enumeration Date | 2009-08-18 |
| Last Update Date | 2014-05-01 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 103TC0700X |
Psychologist Specialization: Clinical |
PY-8336 | FL | Behavioral Health & Social Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| ND | 54516 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1467466656 | Kelly Sipe Russo | Internal Medicine | 1 Harry S Truman Pkwy, Ms 3102, Annapolis, MD 21401-7037 | 2006-07-27 |
| 1487218012 | Kelly Russo | Speech-Language Pathologist | 9047 W Greenfield Ave, West Allis, WI 53214-2800 | 2019-04-29 |
| 1073822409 | Kelly Lynn Russo | Speech-Language Pathologist | 51 St Johns Parkside, Buffalo, NY 14210-2515 | 2010-10-04 |
| 1326362815 | Kelly T Russo | Pharmacist | 11 E Main St, Marcellus, NY 13108-1224 | 2010-03-26 |
| 1770805830 | Kelly White Russo | Pharmacist | 510 E Stoner Ave, Shreveport, LA 71101-4243 | 2010-02-17 |
| 1326115841 | Kelly A Russo | Physical Therapist | 414 Paoli Pike, Malvern, PA 19355-3311 | 2006-11-29 |
| Street Address |
1767 VILLAGE PARK DR |
| City | ORANGEBURG |
| State | SC |
| Zip Code | 29118-2475 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1093768616 | Gordon Reese Weigle II | Family Medicine | 1767 Village Park Dr, Orangeburg, SC 29118-2475 | 2006-05-17 |
| 1366526451 | Janet Paparella Adams | Social Worker | 1767 Village Park Dr, Orangeburg, SC 29118-2475 | 2006-10-25 |
| 1629088513 | Rita Jones Robinson | Internal Medicine | 1767 Village Park Dr, Va Outpatient Clinic, Orangeburg, SC 29118-2475 | 2006-08-09 |
| 1841207198 | William Andy Nuckols | Family Medicine | 1767 Village Park Dr, Orangeburg, SC 29118-2475 | 2006-08-01 |
| 1912945593 | Columbia Vamc | Clinic/Center | 1767 Village Park Dr, Orangeburg, SC 29118-2475 | 2006-06-03 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1386268175 | Sharon Y Tremble | Speech-Language Pathologist | 222 Summit Parkway, Orangeburg, SC 29118 | 2020-06-08 |
| 1922658756 | Orangeburg County School District | Local Education Agency (LEA) | 102 Founders Court, Orangeburg, SC 29118 | 2019-09-13 |
| 1710442967 | Central Carolina Endodontics Pa | Dentist | 888 Cook Road, Orangeburg, SC 29118 | 2019-02-01 |
| 1821572009 | Sharon Fogle | Counselor | 2319 Wt. Matthews Road, Orangeburg, SC 29118 | 2018-09-24 |
| 1104320001 | South Carolina Surgical Pa | Surgery | 3045 St Matthews Road, Orangeburg, SC 29118 | 2018-03-23 |
| 1477056794 | Palmetto Moon Anesthesia, LLC | Anesthesiology | 3045 St. Matthews Rd., Orangeburg, SC 29118 | 2018-03-13 |
| 1730691882 | Bio-medical Applications of South Carolina, Inc. | Clinic/Center | 125 Kinard St, Orangeburg, SC 29118 | 2017-10-30 |
| 1154862746 | Latasha Hott | Nurse Practitioner | 2323 St. Matthews Rd, Orangeburg, SC 29118 | 2017-03-15 |
| 1154786960 | R Dale Padgett Md Pa | Clinic/Center | 1727 Villagepark Dr, Orangeburg, SC 29118 | 2015-12-21 |
| 1881977726 | Ontime Transport LLC | Non-emergency Medical Transport (VAN) | 2851 Pelham Ct, Orangeburg, SC 29118 | 2011-09-27 |
| Find all providers in zip 29118 | ||||
| Taxonomy Code | 103TC0700X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Psychologist |
| Specialization | Clinical |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1992063275 | Behavioral Diagnostics, LLC | Psychologist | 108 Stagecoach Ln, Orangeburg, SC 29118-2499 | 2012-04-24 |
| 1326091323 | Valerie Louise Holmstrom | Psychologist | 1205 Hutto St, Orangeburg, SC 29118-1454 | 2006-05-18 |
| 1356825202 | Kate Cingel | Psychologist | 140 Old Orangeburg Rd, Orangeburg, NY 10962-1157 | 2018-09-17 |
| 1629584537 | Rochelle Tziona Schlachter | Psychologist | 140 Old Orangeburg Rd, Orangeburg, NY 10962-1157 | 2017-12-15 |
| 1548664311 | Priscilla Villavicencio | Psychologist | 140 Old Orangeburg Rd, Orangeburg, NY 10962-1157 | 2014-10-22 |
| 1831592609 | Jessica Rose Heschel | Psychologist | 140 Old Orangeburg Rd, Orangeburg, NY 10962-1157 | 2014-10-07 |
| 1316223407 | Monica Carol Zweig | Psychologist | 140 Old Orangeburg Rd, Psychology Department, Orangeburg, NY 10962 | 2011-11-02 |
| 1821237389 | Reuben Benjamin Ridgeway | Psychologist | 2323 Saint Matthews Rd, Orangeburg, SC 29118-2042 | 2009-02-06 |
| 1386894673 | Lindsay Werkheiser | Psychologist | 140 Old Orangeburg Rd, Building 60, Orangeburg, NY 10962-1157 | 2008-09-24 |
| 1922149459 | Wayne Robert Le Blanc | Psychologist | 140 Old Orangeburg Rd, Orangeburg, NY 10962-1157 | 2007-02-09 |
| Find all providers in ORANGEBURG | ||||
| City | ORANGEBURG |
| Zip Code | 29118 |
Please comment or provide details below to improve the information on DR. KELLY L RUSSO.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.