Active NPI
M. Kathleen Russo, LADC
- Addiction (Substance Use Disorder) Counselor
- Tilton, NH
National Provider Identifier
1821428616
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Addiction (Substance Use Disorder) Counselor
- License
- 0445
- Practice address
- 322 W Main St Ste 101
Riverfront Place
Tilton, NH 03276-5048 - Phone
- (603) 860-1319
- Fax
- (603) 671-7361
- NPI assigned
- Nov 15, 2013
- Last updated
- Jul 21, 2015
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | 0445 | NH | Primary |
Addresses
Primary practice location
322 W Main St Ste 101
Riverfront Place
Tilton, NH 03276-5048
Mailing address
322 W Main St Ste 101
Tilton, NH 03276-5048
Phone (603) 860-1319
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 |
|---|---|---|---|
| 0445 | NH | MD | Addiction (Substance Use Disorder) Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1384473600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1437436800000",
"number": "1821428616",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "322 W MAIN ST STE 101",
"city": "TILTON",
"state": "NH",
"postal_code": "032765048",
"telephone_number": "603-860-1319",
"fax_number": "603-671-7361"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "322 W MAIN ST STE 101",
"address_2": "RIVERFRONT PLACE",
"city": "TILTON",
"state": "NH",
"postal_code": "032765048",
"telephone_number": "603-860-1319",
"fax_number": "603-671-7361"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RUSSO",
"first_name": "M. KATHLEEN",
"credential": "LADC",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2013-11-15",
"last_updated": "2015-07-21",
"status": "A"
},
"taxonomies": [
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "NH",
"license": "0445",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Tilton, NH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.