Organization Active NPI

Karen Russo PHD LLC

  • Psychologist
  • Newark, DE
National Provider Identifier
1104188762
Registry record updated Apr 1, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
License
B1-0000259 Issued in DE
Legal business name
KAREN RUSSO PHD LLC
Practice address
500 Creek View Rd
Suite 109
Newark, DE 19711-8549
Phone
(302) 738-3140
Fax
(302) 454-8026
NPI assigned
Jun 11, 2012
Last updated
Apr 1, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 1, 2015

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

Authorized official

Name
Karen Russo, PHDNPI 1073529905
Title
Owner, Psychologist
Phone
(302) 738-3140

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychologist 103T00000X B1-0000259 DE Primary

Addresses

Primary practice location

500 Creek View Rd
Suite 109
Newark, DE 19711-8549

Mailing address

500 Creek View Rd
Suite 109
Newark, DE 19711-8549
Phone (302) 738-3140

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in DE

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20120920000644 DE Part B Supplier - Clinic/Group Practice 7719135433 Receives reassigned benefits from 1 practitioner
Practice locations: Wilmington, DE

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1339372800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1427846400000",
    "number": "1104188762",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "500 CREEK VIEW RD",
            "address_2": "SUITE 109",
            "city": "NEWARK",
            "state": "DE",
            "postal_code": "197118549",
            "telephone_number": "302-738-3140",
            "fax_number": "302-454-8026"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 CREEK VIEW RD",
            "address_2": "SUITE 109",
            "city": "NEWARK",
            "state": "DE",
            "postal_code": "197118549",
            "telephone_number": "302-738-3140",
            "fax_number": "302-454-8026"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KAREN RUSSO PHD LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-06-11",
        "last_updated": "2015-04-01",
        "status": "A",
        "authorized_official_last_name": "RUSSO",
        "authorized_official_first_name": "KAREN",
        "authorized_official_title_or_position": "OWNER, PSYCHOLOGIST",
        "authorized_official_telephone_number": "302-738-3140",
        "authorized_official_credential": "PHD"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "DE",
            "license": "B1-0000259",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Newark, DE

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 1, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.