Active NPI
Lily Russo, APCC
- Professional Counselor
- Los Angeles, CA
National Provider Identifier
1235960725
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 88-2437354
- Practice address
- 6310 San Vicente Blvd
Los Angeles, CA 90048-5426 - Phone
- (213) 262-3346
- Fax
- (213) 946-4039
- NPI assigned
- Aug 8, 2024
- 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 |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 88-2437354 | CA | Primary |
Addresses
Primary practice location
6310 San Vicente Blvd
Los Angeles, CA 90048-5426
Mailing address
6310 San Vicente Blvd
Los Angeles, CA 90048-5426
Phone (213) 262-3346
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 |
|---|---|---|---|
| 88-2437354 | CA | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1723075200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1723075200000",
"number": "1235960725",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6310 SAN VICENTE BLVD",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900485426",
"telephone_number": "213-262-3346",
"fax_number": "213-946-4039"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6310 SAN VICENTE BLVD",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900485426",
"telephone_number": "213-262-3346",
"fax_number": "213-946-4039"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RUSSO",
"first_name": "LILY",
"credential": "APCC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2024-08-08",
"last_updated": "2024-08-08",
"certification_date": "2024-08-08",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "CA",
"license": "88-2437354",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Los Angeles, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 8, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.