Active NPI
Rachel Russell
- Clinical Psychologist
- Indialantic, FL
National Provider Identifier
1023508710
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- PY8845
- Practice address
- 122 4TH Ave Ste 200
Indialantic, FL 32903-3112 - Phone
- (321) 327-3793
- NPI assigned
- May 17, 2018
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | PY8845 | FL | Primary |
Addresses
Primary practice location
122 4TH Ave Ste 200
Indialantic, FL 32903-3112
Mailing address
241 Sand Dollar Rd
Indialantic, FL 32903-2111
Phone (321) 427-5512
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PY8845 | FL | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1526515200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1526515200000",
"number": "1023508710",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "241 SAND DOLLAR RD",
"city": "INDIALANTIC",
"state": "FL",
"postal_code": "329032111",
"telephone_number": "321-427-5512"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "122 4TH AVE STE 200",
"city": "INDIALANTIC",
"state": "FL",
"postal_code": "329033112",
"telephone_number": "321-327-3793"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RUSSELL",
"first_name": "RACHEL",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2018-05-17",
"last_updated": "2018-05-17",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "FL",
"license": "PY8845",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Indialantic, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 17, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.