KELLIE MARIE RUSSO


Address: 460 Brielle Ave, Staten Island, NY 10314-6427
Phone: 7184123156

KELLIE MARIE RUSSO (NPI# 1548825151) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1548825151
Entity Type Individual
Full Name KELLIE MARIE RUSSO
Credential CASAC-2
Practice Address 460 Brielle Ave
Staten Island
NY 10314-6427
Practice Telephone 7184123156
Practice Fax Number 7183563155
Mailing Telephone 7184123156
Mailing Fax Number 7183563155
Enumeration Date 2019-05-08
Last Update Date 2019-05-08
Gender Code F
Is Sole Proprietor N

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
Y 101YA0400X Counselor
Specialization: Addiction (Substance Use Disorder)
29679 NY Behavioral Health & Social Service Providers

Other Provider Identifier

State Issuer Identifier Type Code
NY CASAC 29679 01

Office Location

Street Address 460 BRIELLE AVE
City STATEN ISLAND
State NY
Zip Code 10314-6427

Providers in the same location

NPI Name Taxonomy Address Enumeration
1134117500 Volunteer Heart Resuscitation Unit and Ambulance Corps of Staten Isla Ambulance 460 Brielle Ave, Staten Island, NY 10306-0252 2005-10-11
1164044251 Vincent James Onwuemene Nurse Practitioner 460 Brielle Ave, Staten Island, NY 10314-6427 2020-05-12
1811537657 Evan Michael Rosen Counselor 460 Brielle Ave, Staten Island, NY 10314-6427 2020-01-09
1134770613 Myron Priester Counselor 460 Brielle Ave, Staten Island, NY 10314-1031 2019-09-25
1174084131 Frank Robert Caruso Counselor 460 Brielle Ave, Staten Island, NY 10314-6427 2019-03-30
1760942163 Troy Schaffer Counselor 460 Brielle Ave, Staten Island, NY 10314-6427 2019-03-21
1629547013 Jeffrey Smith Counselor 460 Brielle Ave, Staten Island, NY 10314-6427 2018-11-15
1164990347 Stacy G Pagan Counselor 460 Brielle Ave, Staten Island, NY 10314-6427 2018-11-06
1609300367 Trevor Griffiths Counselor 460 Brielle Ave, Building H, Staten Island, NY 10314-6427 2017-04-19
1346784691 Terry Grayton Counselor 460 Brielle Ave, Staten Island, NY 10314-6427 2016-12-06
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Providers in the same zip code

NPI Name Taxonomy Address Enumeration
1568076255 Edward Leccese Massage Therapist 77 Renee Place, Staten Island, NY 10314 2020-09-01
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1750845137 Miriam Gordon Pediatric Np PC Nurse Practitioner 7 Ismay Street, Staten Island, NY 10314 2019-01-30
1003391186 2791 Richmond LLC Dentist 2791 Richmond Avenue, Suite 2, Staten Island, NY 10314 2018-09-25
1477046522 Miriam A Madry Optometrist 569 Woolley Ave, Staten Island, NY 10314 2018-06-13
1174025894 Staten Island Dentistry P.C. Clinic/Center 979 Willowbrook Rd., Staten Island, NY 10314 2018-03-08
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1306369699 Victoria Ali Behavior Technician 228 Melvin Avenue, Staten Island, NY 10314 2017-07-19
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Taxonomy Information

Taxonomy Code 101YA0400X
Grouping Behavioral Health & Social Service Providers
Classification Counselor
Specialization Addiction (Substance Use Disorder)

Taxonomy Definition

Definition to come...

Providers in the same taxonomy and city

NPI Name Taxonomy Address Enumeration
1134743776 Prudence Salvato Counselor 109 Kelvin Ave, Staten Island, NY 10306-3743 2020-05-29
1487122511 James Anthony Badillo Counselor 460 Brielle Ave Bldg H, Staten Island, NY 10314-6427 2018-11-07
1154706901 Bilal Abdullah Counselor 1268 Forest Ave, Staten Island, NY 10302-2312 2015-07-22
1144603713 Edwin Rivera Counselor 181 Mosely Ave, Staten Island, NY 10312-4163 2015-07-01
1508252420 Melissa Forsyth Counselor 240 Woolley Ave, Staten Island, NY 10314-2002 2015-04-07
1508138355 Georgener Winfield Counselor 263-267 Port Richmond Ave, Staten Island, NY 10302 2012-02-08
1073885687 Carol A Casey Counselor 263 -267 Port Richmond Ave, Staten Island, NY 10302 2012-01-30
1275805871 Barbara Carioti Counselor 263-267 Port Richmond Avenue, Staten Island, NY 10302 2012-01-30
1669743423 Debora Blanford-gaskin Counselor 263/267 Port Richmond Ave, Staten Island, NY 10302 2012-01-25
1386915478 Arthur Joseph Sagevick Jr. Counselor 3911 Richmond Avenue, Staten Island, NY 10312 2012-01-20
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Competitor

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City STATEN ISLAND
Zip Code 10314

Improve Information

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Dataset Information

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.

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