Active NPI
Angelique Noel Russo, M.S.
- Marriage & Family Therapist
- San Bernardino, CA
National Provider Identifier
1376742155
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Marriage & Family Therapist
- License
- 54731
- Practice address
- 1053 N D St
San Bernardino, CA 92410-3521 - Phone
- (909) 886-1691
- NPI assigned
- Jul 12, 2007
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | |||
| Marriage & Family Therapist | 106H00000X | 54731 | CA | Primary |
Addresses
Primary practice location
1053 N D St
San Bernardino, CA 92410-3521
Mailing address
1053 N D St
San Bernardino, CA 92410-3521
Phone (909) 886-1691
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
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 54731 | CA | MD | Marriage & Family Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1184198400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1193270400000",
"number": "1376742155",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1053 N D ST",
"city": "SAN BERNARDINO",
"state": "CA",
"postal_code": "924103521",
"telephone_number": "909-886-1691"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1053 N D ST",
"city": "SAN BERNARDINO",
"state": "CA",
"postal_code": "924103521",
"telephone_number": "909-886-1691"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RUSSO",
"first_name": "ANGELIQUE",
"middle_name": "NOEL",
"name_prefix": "Ms.",
"credential": "M.S.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-07-12",
"last_updated": "2007-10-25",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": null,
"license": null,
"primary": false
},
{
"code": "106H00000X",
"taxonomy_group": "",
"desc": "Marriage & Family Therapist",
"state": "CA",
"license": "54731",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Bernardino, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 25, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.