Angela Russo, LCPC, CADC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

XL3802 Issued in ME

Practice address

14 Main Street
Mars Hill, ME 04758

Phone

(207) 425-3880

NPI assigned

Dec 6, 2012

Last updated

Dec 6, 2012By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• The Northern Lighthouse Inc

  • Emotionally Disturbed Childrens' Residential Treatment Facility
  • Mars Hill, ME
  • NPI 1013244797
  NPD (past)

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

{
    "created_epoch": "1354752000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1354752000000",
    "number": "1770828469",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "378 DEVELOPMENT DR",
            "city": "LIMESTONE",
            "state": "ME",
            "postal_code": "047506128",
            "telephone_number": "303-520-4618"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14 MAIN STREET",
            "city": "MARS HILL",
            "state": "ME",
            "postal_code": "04758",
            "telephone_number": "207-425-3880"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUSSO",
        "first_name": "ANGELA",
        "credential": "LCPC, CADC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2012-12-06",
        "last_updated": "2012-12-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "ME",
            "license": "CAC4911",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "ME",
            "license": "XL3802",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Msad 42
• Eric Finlay Nicholas, MD
• Northern Lighthouse Inc.
• Nancy Theresa O'Neill, MD
• Kate Lindsay Robbins, SLPA
• Sheila Ann Shaw, MSW-CC
• Stiles Family Practice
• Shelby Jean Stiles, FNP
• The Aroostook Medical Center (Northern Light Continuing Care, Mars Hill)
• The Northern Lighthouse Inc

• Professional Counselor in Mars Hill, ME
• Providers in Mars Hill, ME by specialty
• Professional Counselor in Maine

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 6, 2012; 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.