Courtney Nicole Russell, M.A., BCBA

Primary specialty

Behavior AnalystTaxonomy code 103K00000X

License

1-21-55823 Issued in DE

Practice address

510 Philadelphia Pike
Wilmington, DE 19809-2100

Phone

(302) 762-2636

NPI assigned

Dec 9, 2021

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Arts

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.

• Brandywine Center for Autism, LLC

  dba Brightbloom Centers

  • Community/Behavioral Health Agency
  • Wilmington, DE
  • NPI 1649673427
  NPD (past)

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

{
    "created_epoch": "1639008000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1639008000000",
    "number": "1477212215",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "510 PHILADELPHIA PIKE",
            "city": "WILMINGTON",
            "state": "DE",
            "postal_code": "198092100",
            "telephone_number": "302-762-2636"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "510 PHILADELPHIA PIKE",
            "city": "WILMINGTON",
            "state": "DE",
            "postal_code": "198092100",
            "telephone_number": "302-762-2636"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUSSELL",
        "first_name": "COURTNEY",
        "middle_name": "NICOLE",
        "credential": "M.A., BCBA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-12-09",
        "last_updated": "2021-12-09",
        "certification_date": "2021-12-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": "DE",
            "license": "1-21-55823",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1649673427",
            "state": null
        }
    ],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "Portia",
            "affiliation": "N",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "510 Philadelphia Pike",
            "city": "Wilmington",
            "state": "DE",
            "country_code": "US",
            "postal_code": "198092100",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Kathleen Marie Rupertus, PSYD
• Sarah Russel, RD
• Russell J Tibbetts DDS PA
• Bethany Ann Russell
• Charles Russell
• Rebecca Jean Russell, MD
• Frances Russo-Avena
• John N Russo, DDS
• Kimberly A. Russo, CRNA
• Nicholas J. Russo, D.M.D

• Behavior Analyst in Wilmington, DE
• Providers in Wilmington, DE by specialty
• Behavior Analyst in Delaware

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 9, 2021; 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.