Active NPI
John Russotto, LCSW
- Clinical Social Worker
- Washington, DC
National Provider Identifier
1619066933
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 17933
- Practice address
- 1616 18TH St NW Ste 111
Washington, DC 20009-2521 - Phone
- (202) 249-1163
- Fax
- (703) 658-9306
- NPI assigned
- Oct 12, 2006
- Sex
- Male
- Sole proprietor
- No
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 | 17933 | FL | Primary |
Addresses
Primary practice location
1616 18TH St NW Ste 111
Washington, DC 20009-2521
Mailing address
5510 La Puerta del Sol Blvd S Apt 234
Saint Petersburg, FL 33715-1426
Phone (727) 710-5487
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 17933 | FL | MD | Occupational Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1160611200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1629763200000",
"number": "1619066933",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5510 LA PUERTA DEL SOL BLVD S APT 234",
"city": "SAINT PETERSBURG",
"state": "FL",
"postal_code": "337151426",
"telephone_number": "727-710-5487"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1616 18TH ST NW STE 111",
"city": "WASHINGTON",
"state": "DC",
"postal_code": "200092521",
"telephone_number": "202-249-1163",
"fax_number": "703-658-9306"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RUSSOTTO",
"first_name": "JOHN",
"credential": "LCSW",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-10-12",
"last_updated": "2021-08-24",
"certification_date": "2021-08-24",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "FL",
"license": "17933",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Washington, DC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 24, 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.