Patrick Joseph Russolillo, PH.D

Primary specialty

Clinical Child & Adolescent PsychologistTaxonomy code 103TC2200X

License

0001383 Issued in CT

Practice address

154 College St
Middletown, CT 06457-3201

Phone

(860) 344-9694

Fax

(860) 346-2947

NPI assigned

Jan 15, 2007

Sex

Male

Sole proprietor

Yes

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

Enrolled in CT

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

Clinical Psychologist

Education

Other, 1986

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

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.

• College Street Counseling Center LLC

  • Clinical Social Worker
  • Middletown, CT
  • NPI 1093089948
  NPD (past)

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

{
    "created_epoch": "1168819200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1366593477",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "238 TIMBER RIDGE RD",
            "city": "MIDDLETOWN",
            "state": "CT",
            "postal_code": "064571538",
            "telephone_number": "860-344-9694",
            "fax_number": "860-346-2947"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "154 COLLEGE ST",
            "city": "MIDDLETOWN",
            "state": "CT",
            "postal_code": "064573201",
            "telephone_number": "860-344-9694",
            "fax_number": "860-346-2947"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUSSOLILLO",
        "first_name": "PATRICK",
        "middle_name": "JOSEPH",
        "name_prefix": "Dr.",
        "credential": "PH.D",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-01-15",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC2200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical Child & Adolescent",
            "state": "CT",
            "license": "0001383",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Rushford Center Inc
• Rushford Center Inc
• Linda Karen Russell, PH.D.
• John Russo, D.M.D.
• Katie Ann Russo, LCSW
• McLaine Riley Rutan, AU.D.
• Carolyn Camire Ruutel, LCSW
• Joseph Anthony Sabbatino, MD
• Ashley M Sabol, PT, DPT
• Alanna Sade-Milberg, APRN

• Clinical Child & Adolescent Psychologist in Middletown, CT
• Providers in Middletown, CT by specialty
• Clinical Child & Adolescent Psychologist in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.