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).
| 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 |
| 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 |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NY | CASAC | 29679 | 01 |
| Street Address |
460 BRIELLE AVE |
| City | STATEN ISLAND |
| State | NY |
| Zip Code | 10314-6427 |
| 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 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1568076255 | Edward Leccese | Massage Therapist | 77 Renee Place, Staten Island, NY 10314 | 2020-09-01 |
| 1871154633 | Matthew Richard Puliatti | Counselor | 1688 Victory Boulevard, Staten Island, NY 10314 | 2019-06-24 |
| 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 |
| 1205335023 | Ashley Larsen | Early Intervention Provider Agency | 229 Wellington Ct, Staten Island, NY 10314 | 2018-02-07 |
| 1306369699 | Victoria Ali | Behavior Technician | 228 Melvin Avenue, Staten Island, NY 10314 | 2017-07-19 |
| 1700307360 | Lydia Mora | Specialist | 2025 Richmond Avenue Suite 200, Staten Island, NY 10314 | 2017-07-03 |
| 1366971707 | Lisa Pietracatella | Massage Therapist | 92 Margaretta Court, Staten Island, NY 10314 | 2017-06-08 |
| Find all providers in zip 10314 | ||||
| Taxonomy Code | 101YA0400X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Counselor |
| Specialization | Addiction (Substance Use Disorder) |
| Definition to come... |
| 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 |
| Find all providers in STATEN ISLAND | ||||
| City | STATEN ISLAND |
| Zip Code | 10314 |
Please comment or provide details below to improve the information on KELLIE MARIE 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.