Active NPI
James Michael Russo
- Clinical Social Worker
- Reisterstown, MD
National Provider Identifier
1477022333
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 05620
- Practice address
- 12039 Reisterstown Rd
Reisterstown, MD 21136-3042 - Phone
- (443) 881-2024
- Fax
- (410) 833-4102
- NPI assigned
- Nov 20, 2018
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 05620 | MD | Primary |
Addresses
Primary practice location
12039 Reisterstown Rd
Reisterstown, MD 21136-3042
Mailing address
12039 Reisterstown Rd
Reisterstown, MD 21136-3042
Phone (443) 881-2024
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 |
|---|---|---|---|
| 05620 | MD | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1542672000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1542672000000",
"number": "1477022333",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "12039 REISTERSTOWN RD",
"city": "REISTERSTOWN",
"state": "MD",
"postal_code": "211363042",
"telephone_number": "443-881-2024",
"fax_number": "410-833-4102"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12039 REISTERSTOWN RD",
"city": "REISTERSTOWN",
"state": "MD",
"postal_code": "211363042",
"telephone_number": "443-881-2024",
"fax_number": "410-833-4102"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RUSSO",
"first_name": "JAMES",
"middle_name": "MICHAEL",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2018-11-20",
"last_updated": "2018-11-20",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "MD",
"license": "05620",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Reisterstown, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 20, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.