Carol K Russo, LMFT

Primary specialty

Marriage & Family TherapistTaxonomy code 106H00000X

License

4054 Issued in SC

Practice address

1107 48TH Ave N
Suite 111-E
Myrtle Beach, SC 29577-5443

Phone

(843) 254-9447

Fax

(843) 449-8753

NPI assigned

Oct 22, 2007

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 identifiers 1

Medicare fee-for-service enrollment

Enrolled in SC

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Marriage and Family Therapist

Education

Other, 1983

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1193011200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1201824000000",
    "number": "1346439742",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1107 48TH AVE. NO.",
            "address_2": "PARKWAY OFFICE PLAZA SUITE 111-E",
            "city": "MYRTLE BEACH",
            "state": "SC",
            "postal_code": "295775926",
            "telephone_number": "843-254-9447",
            "fax_number": "843-449-8753"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1107 48TH AVE N",
            "address_2": "SUITE 111-E",
            "city": "MYRTLE BEACH",
            "state": "SC",
            "postal_code": "295775443",
            "telephone_number": "843-254-9447",
            "fax_number": "843-449-8753"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUSSO",
        "first_name": "CAROL",
        "middle_name": "K",
        "credential": "LMFT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-10-22",
        "last_updated": "2008-02-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "SC",
            "license": "4054",
            "primary": true
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "NC",
            "license": "1120",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6105147",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Shannon Rumpf
• Rupa Shetty LLC
• Jan C Rusenko
• Challis Evelyn Russell, MA, LPC
• Jamie Russell
• Brianna Ryan
• Patrick Keith Ryan, D.O.
• Sarah Exum Ryan, PA-C
• Thuy P. Ryan, D.O.
• Caroline Elaine Ryerson

• Marriage & Family Therapist in Myrtle Beach, SC
• Providers in Myrtle Beach, SC by specialty
• Marriage & Family Therapist in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 1, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.