Jillian Russo, PSYD

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

10434 Issued in MA

Practice address

115 Mill St
Belmont, MA 02478-1048

Phone

(617) 855-3900

NPI assigned

Jun 28, 2013

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other names 1

• Jillian Russo-Goodwin Other name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: russo.jillian.mcl@direct.partners.masshiway.net

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• The McLean Hospital Corporation

  • Psychiatry Physician
  • Belmont, MA
  • NPI 1114979580

  Clinical

  NPD

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

{
    "created_epoch": "1372377600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1625011200000",
    "number": "1184064636",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "115 MILL ST",
            "city": "BELMONT",
            "state": "MA",
            "postal_code": "024781048"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "115 MILL ST",
            "city": "BELMONT",
            "state": "MA",
            "postal_code": "024781048",
            "telephone_number": "617-855-3900"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUSSO",
        "first_name": "JILLIAN",
        "name_prefix": "Dr.",
        "credential": "PSYD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-06-28",
        "last_updated": "2021-06-30",
        "certification_date": "2021-06-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "MA",
            "license": "10434",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JILLIAN",
            "last_name": "RUSSO-GOODWIN",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Isabelle M Rosso, PH.D.
• Dana Beth Roth
• Noelle Rubel, APRN, BC
• Rachel Rubin
• Janet Lee Russo, LICSW
• William B Ruzicka, MD, PHD
• Rima Saad, PH.D.
• Susan Marilyn Sachs, LICSW
• Elisabeth Sackton, MSW, LICSW
• Rina Kaur Sahi, O.D

• Clinical Psychologist in Belmont, MA
• Providers in Belmont, MA by specialty
• Clinical Psychologist in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 30, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.