Joan Carol Russo, PH.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

1169 Issued in WI

Practice address

W340N6509 Breezy Point Rd
Oconomowoc, WI 53066-5132

Phone

(262) 490-9114

NPI assigned

Jul 19, 2005

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

HHS exclusion list flag

Flagged The directory lists this NPI on an HHS exclusion list. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.

Credentials

Doctor of Philosophy

Practice roles

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.

• Center for Behavioral Medicine, SC

  • Clinical Psychologist
  • Brookfield, WI
  • NPI 1578515417
  NPD (past)

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

{
    "created_epoch": "1121731200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1404691200000",
    "number": "1225037575",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "W340N6509 BREEZY POINT RD",
            "city": "OCONOMOWOC",
            "state": "WI",
            "postal_code": "530665132",
            "telephone_number": "262-490-9114"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "W340N6509 BREEZY POINT RD",
            "city": "OCONOMOWOC",
            "state": "WI",
            "postal_code": "530665132",
            "telephone_number": "262-490-9114"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUSSO",
        "first_name": "JOAN",
        "middle_name": "CAROL",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2005-07-19",
        "last_updated": "2014-07-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "WI",
            "license": "1169",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "39114000",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Roundys Supermarkets Inc
• Angelica M Rowin-Fox, FNP
• Kim R. Ruffalo, OTR, CLT-LANA
• Thomas Ruffalo, PA
• Samantha Jean Ruiz, D.D.S.
• Jeffrey Daniel Rutkowski, D.C.
• Jan E Rutledge, RN
• M Fay Sanders, LCSW
• Sarah Jean Sanford-Smith, MSN FNP-C
• Gordon Sauer, R.PH., MS, FASCP

• Clinical Psychologist in Oconomowoc, WI
• Providers in Oconomowoc, WI by specialty
• Clinical Psychologist in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 7, 2014; 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.