Active NPI
Jessica Marie Russo
- Social Worker
- Plainville, CT
National Provider Identifier
1124683040
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Social Worker
- License
- 4715
- Practice address
- 24 Elizabeth CT FL 1B-2
Plainville, CT 06062-2755 - Phone
- (203) 788-9874
- NPI assigned
- May 6, 2019
- 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 |
|---|---|---|---|---|
| Social Worker | 104100000X | 4715 | CT | Primary |
Addresses
Primary practice location
24 Elizabeth CT FL 1B-2
Plainville, CT 06062-2755
Mailing address
24 Elizabeth CT FL 1B-2
Plainville, CT 06062-2755
Phone (203) 788-9874
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 |
|---|---|---|---|
| 4715 | CT | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1557100800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1557100800000",
"number": "1124683040",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "24 ELIZABETH CT FL 1B-2",
"city": "PLAINVILLE",
"state": "CT",
"postal_code": "060622755",
"telephone_number": "203-788-9874"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "24 ELIZABETH CT FL 1B-2",
"city": "PLAINVILLE",
"state": "CT",
"postal_code": "060622755",
"telephone_number": "203-788-9874"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RUSSO",
"first_name": "JESSICA",
"middle_name": "MARIE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2019-05-06",
"last_updated": "2019-05-06",
"status": "A"
},
"taxonomies": [
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "CT",
"license": "4715",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Plainville, CT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 6, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.