Active NPI
Anne Paulette Russo, LICSW
- Clinical Social Worker
- Holden, MA
National Provider Identifier
1063472181
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 107716
- Practice address
- 1349 Main St
Holden, MA 01520 - Phone
- (508) 829-2771
- Fax
- (508) 829-2774
- NPI assigned
- Mar 24, 2006
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | R040227-1 | NY | |
| Clinical Social Worker | 1041C0700X | 107716 | MA | Primary |
Addresses
Primary practice location
1349 Main St
Holden, MA 01520
Mailing address
1349 Main St
Holden, MA 01520
Phone (508) 829-2771
Other identifiers 7
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 252503 | Other | MA | MAGELLAN |
| P07193 | Other | MA | BLUE CROSS/BLUE SHIELD MA |
| 4474067 | Other | MA | AETNA |
| 1019909 | Other | MA | CIGNA |
| 6232034 | Other | MA | UNITED HEALTHCARE |
| 9073175 | Other | MA | PHCS |
| 421376MS | Other | MA | HARVARD PILGRIM/PACIFICAR |
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 107716 | MA | MD | Clinical Social Worker |
| R040227-1 | NY | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1143158400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1063472181",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1349 MAIN ST",
"city": "HOLDEN",
"state": "MA",
"postal_code": "01520",
"telephone_number": "508-829-2771",
"fax_number": "508-829-2774"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1349 MAIN ST",
"city": "HOLDEN",
"state": "MA",
"postal_code": "01520",
"telephone_number": "508-829-2771",
"fax_number": "508-829-2774"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RUSSO",
"first_name": "ANNE",
"middle_name": "PAULETTE",
"credential": "LICSW",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-03-24",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "NY",
"license": "R040227-1",
"primary": false
},
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "MA",
"license": "107716",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MAGELLAN",
"identifier": "252503",
"state": "MA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS/BLUE SHIELD MA",
"identifier": "P07193",
"state": "MA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA",
"identifier": "4474067",
"state": "MA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CIGNA",
"identifier": "1019909",
"state": "MA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UNITED HEALTHCARE",
"identifier": "6232034",
"state": "MA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PHCS",
"identifier": "9073175",
"state": "MA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HARVARD PILGRIM/PACIFICAR",
"identifier": "421376MS",
"state": "MA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Holden, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.