Deirdre Lee Russo, MFT

Primary specialty

Marriage & Family TherapistTaxonomy code 106H00000X

License

P97555 Issued in NY

Practice address

100 S Jersey Ave
Suite 42
East Setauket, NY 11733-2034

Phone

(631) 689-1728

NPI assigned

Oct 16, 2015

Sex

Female

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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.

• Mind and Body Wellness

  • Marriage & Family Therapist
  • Oakdale, NY
  • NPI 1477233187
  NPD Authorized official
• Paul J Botticelli LCSW PC

  • Clinical Social Worker
  • Coram, NY
  • NPI 1881294338
  NPD (past)
• Setauket Licensed Clinical Social Work Consultation Services PLLC

  • Clinical Social Worker
  • East Setauket, NY
  • NPI 1801073184
  NPD (past)

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

{
    "created_epoch": "1444953600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1444953600000",
    "number": "1457722464",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8 WINMAR LN",
            "city": "SAYVILLE",
            "state": "NY",
            "postal_code": "117821371",
            "telephone_number": "631-404-6431"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 S JERSEY AVE",
            "address_2": "SUITE 42",
            "city": "EAST SETAUKET",
            "state": "NY",
            "postal_code": "117332034",
            "telephone_number": "631-689-1728"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUSSO",
        "first_name": "DEIRDRE",
        "middle_name": "LEE",
        "name_prefix": "Ms.",
        "credential": "MFT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2015-10-16",
        "last_updated": "2015-10-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "NY",
            "license": "P97555",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Arthur Rosiello, M.D.
• Daliah Hope Ross, PHD
• Deborah Anne Roth, NP
• Harriette Rovner-Ferguson, LCSW
• Juby Ann Roy, DO
• Gwendolyn Casey Russo
• S.O.S. Mental Health Counseling PLLC
• Saima Saboohi, SEITH
• Jason A Sadlofsky, DO
• Michelle Anne Salerno, RN

• Marriage & Family Therapist in East Setauket, NY
• Providers in East Setauket, NY by specialty
• Marriage & Family Therapist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 16, 2015; 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.