Sandra Jean Russalesi, L.C.S.W.

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

992689 Issued in CO

Practice address

1800 Colorado Blvd.
Idaho Springs, CO 80452-3304

Phone

(303) 349-5114

NPI assigned

Oct 4, 2007

Last updated

Oct 4, 2007By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in CO

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1191456000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1191456000000",
    "number": "1023206034",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3304",
            "city": "IDAHO SPRINGS",
            "state": "CO",
            "postal_code": "804523304",
            "telephone_number": "303-567-0678",
            "fax_number": "303-567-9723"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1800 COLORADO BLVD.",
            "city": "IDAHO SPRINGS",
            "state": "CO",
            "postal_code": "804523304",
            "telephone_number": "303-349-5114"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUSSALESI",
        "first_name": "SANDRA",
        "middle_name": "JEAN",
        "credential": "L.C.S.W.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-10-04",
        "last_updated": "2007-10-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "CO",
            "license": "992689",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CO",
            "license": "992689",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mark O'Laughlin, MA, LPC
• Jennifer Nicole Pearse
• Sherri A Potter
• Rite of Passage Inc
• Vonnie Lynne Rouse, FNP
• Safeway Inc (Safeway Pharmacy #0390)
• Nicole Savage, RDH
• Stephen Mark Selby, RPH
• Kari Ann Smith, RD/RDN
• Robert J Sparrow, D.C.

• Clinical Social Worker in Idaho Springs, CO
• Providers in Idaho Springs, CO by specialty
• Clinical Social Worker in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 4, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.