Deborah J. Russo, PHD

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

3986 Issued in NC

Practice address

905 Johns Hopkins Dr
Ecu Physicians Psychiatric Medicine Outpatient Center
Greenville, NC 27834-7225

Phone

(252) 744-1406

Fax

(252) 744-2419

NPI assigned

Mar 29, 2007

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

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

{
    "created_epoch": "1175126400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1320796800000",
    "number": "1629197546",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 751069",
            "address_2": "ECU PHYSICIANS",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282751069"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "905 JOHNS HOPKINS DR",
            "address_2": "ECU PHYSICIANS PSYCHIATRIC MEDICINE OUTPATIENT CENTER",
            "city": "GREENVILLE",
            "state": "NC",
            "postal_code": "278347225",
            "telephone_number": "252-744-1406",
            "fax_number": "252-744-2419"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUSSO",
        "first_name": "DEBORAH",
        "middle_name": "J.",
        "credential": "PHD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-03-29",
        "last_updated": "2011-11-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "NC",
            "license": "3986",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBSNC",
            "identifier": "162G7",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6001277",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jackson Russell
• Keith Russell, PT, DPT
• Madison Gardner Russell
• Shaunta Russell
• Trey Russell
• Carmen Vincent Russoniello Sr., PHD
• Alicia Moore Rutherford
• Sharon Rutledge, AUD.
• Ryan T. Pruitt, D.M.D & Associates P.a.
• David Hallmark Ryan, M.D.

• Clinical Psychologist in Greenville, NC
• Providers in Greenville, NC by specialty
• Clinical Psychologist in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 9, 2011; 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.