Stephen A. Russo, PH.D

Primary specialty

PsychologistTaxonomy code 103T00000X

License

PS015087 Issued in PA

Practice address

3300 Township Line Rd
Drexel Hill, PA 19026-1925

Phone

(484) 818-2225

Fax

(866) 818-4032

NPI assigned

Dec 5, 2008

Last updated

Feb 8, 2020By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Enrolled in PA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

Locations

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.

• Philadelphia Concussion Specialists

  • Clinical Psychologist
  • Drexel Hill, PA
  • NPI 1831732007
  Authorized official Same address or phone
• Springfield Psychological PC

  dba Associates of Springfield Psychological

  • Mental Health Counselor
  • Springfield, PA
  • NPI 1295705317
  NPD

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

{
    "created_epoch": "1228435200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1581120000000",
    "number": "1902041825",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 741",
            "city": "MEDIA",
            "state": "PA",
            "postal_code": "190630741",
            "telephone_number": "484-818-2225",
            "fax_number": "866-818-4032"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3300 TOWNSHIP LINE RD",
            "city": "DREXEL HILL",
            "state": "PA",
            "postal_code": "190261925",
            "telephone_number": "484-818-2225",
            "fax_number": "866-818-4032"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUSSO",
        "first_name": "STEPHEN",
        "middle_name": "A.",
        "credential": "PH.D",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-12-05",
        "last_updated": "2020-02-08",
        "certification_date": "2020-02-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TE1100X",
            "taxonomy_group": "",
            "desc": "Psychologist, Exercise & Sports",
            "state": "PA",
            "license": "PS015087",
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "PA",
            "license": "PS015087",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Beatrice Aderonke Rotibi, M.D.
• Alison G. Rubin, MD, MSC, IBCLC
• Donald R Ruch Jr., DMD
• Michael John Ruggieri Jr., DMD
• Cesar E Ruiz, SLP.D.
• Pasquale John Russoniello, M.A.
• Patrick Rutledge, PT, DPT
• Riya Sabu
• Jay E Salee, M.S.E.D., LBS
• Michelle Salera

• Psychologist in Drexel Hill, PA
• Providers in Drexel Hill, PA by specialty
• Psychologist in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 8, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.