Diana Marie Russo

Primary specialty

Student in an Organized Health Care Education/Training ProgramTaxonomy code 390200000X

Practice address

4035 NE Sandy Blvd Ste 240
Portland, OR 97212-5331

Phone

(971) 940-2601

NPI assigned

May 24, 2024

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Practice roles

Locations

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.

• Portland Neurofeedback, LLC

  dba The PATH Center

  • Mental Health Counselor
  • Portland, OR
  • NPI 1558875476
  NPD
• Larsen Sanchez Psychology, LLC

  dba Portland Mental Health & Wellness

  • Clinical Psychologist
  • Portland, OR
  • NPI 1588041388
  NPD (past)

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

{
    "created_epoch": "1716508800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1716508800000",
    "number": "1356181606",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4035 NE SANDY BLVD STE 240",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972125331",
            "telephone_number": "971-940-2601"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4035 NE SANDY BLVD STE 240",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972125331",
            "telephone_number": "971-940-2601"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUSSO",
        "first_name": "DIANA",
        "middle_name": "MARIE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-05-24",
        "last_updated": "2024-05-24",
        "certification_date": "2024-05-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tammy Lee Russell, RDN
• Russellville III LLC (Russellville Park)
• Kristin Russio
• Barry Sheldon Russman, MD
• Andrea Russo, CRM
• Haley Russo
• Larry Russock
• Bethany Russotto, PA-C
• Chloe Rust
• Randee L Rust, LMT

• Student in an Organized Health Care Education/Training Program in Portland, OR
• Providers in Portland, OR by specialty
• Student in an Organized Health Care Education/Training Program in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 24, 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.

Verify at the official NPI Registry.