Active NPI
Nicole Russo
- Massage Therapist
- Stoneham, MA
National Provider Identifier
1356572747
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Massage Therapist
- License
- 2452
- Practice address
- 38 Montvale Ave Ste 330
Stoneham, MA 02180-2450 - Phone
- (978) 886-5441
- NPI assigned
- Aug 3, 2009
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Massage Therapist | 225700000X | 2452 | MA | Primary |
Addresses
Primary practice location
38 Montvale Ave Ste 330
Stoneham, MA 02180-2450
Mailing address
163 West St Apt 3
Malden, MA 02148-6532
Phone (978) 886-5441
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 |
|---|---|---|---|
| 2452 | MA | MD | Registered Dietitian |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1249257600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1249257600000",
"number": "1356572747",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "163 WEST ST APT 3",
"city": "MALDEN",
"state": "MA",
"postal_code": "021486532",
"telephone_number": "978-886-5441"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "38 MONTVALE AVE STE 330",
"city": "STONEHAM",
"state": "MA",
"postal_code": "021802450",
"telephone_number": "978-886-5441"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RUSSO",
"first_name": "NICOLE",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2009-08-03",
"last_updated": "2009-08-03",
"status": "A"
},
"taxonomies": [
{
"code": "225700000X",
"taxonomy_group": "",
"desc": "Massage Therapist",
"state": "MA",
"license": "2452",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Stoneham, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 3, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.