Minette Russell-Irace, PSY.D

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

021071 Issued in NY

Practice address

203 Clifton PL
Suite 10
Brooklyn, NY 11216-5181

Phone

(845) 272-2118

NPI assigned

Jan 13, 2015

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

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.

Opted out of Medicare

Yes, effective Nov 2, 2015 through Nov 2, 2027

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1421107200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1549324800000",
    "number": "1417346537",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "203 CLIFTON PL",
            "address_2": "SUITE 10",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112165181",
            "telephone_number": "845-272-2118"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "203 CLIFTON PL",
            "address_2": "SUITE 10",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112165181",
            "telephone_number": "845-272-2118"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "208 Washington Park",
            "address_2": "1B",
            "address_purpose": "LOCATION",
            "city": "Brooklyn",
            "state": "NY",
            "postal_code": "112054057",
            "country_code": "US",
            "telephone_number": "347-229-7037",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "RUSSELL-IRACE",
        "first_name": "MINETTE",
        "credential": "PSY.D",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2015-01-13",
        "last_updated": "2019-02-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "NY",
            "license": "021071",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Marshawn Russ
• Simcha Russ
• Lisa Russak, NP
• Sara Russak
• Reuven Russek
• Abigail Siobhan Russell, MHC-LP
• Arianna Russell
• Bridget Russell
• Candice Russell
• Christopher Paul Russell, MS. ED., TVI

• Clinical Psychologist in Brooklyn, NY
• Providers in Brooklyn, NY by specialty
• Clinical Psychologist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 5, 2019; 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; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.