Nicole Russo, LISW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

I.2405587 Issued in OH

Practice address

398 W Bagley Rd Ste 13
Berea, OH 44017-1312

Phone

(440) 970-3790

Fax

(440) 527-8043

NPI assigned

Sep 10, 2020

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 1

Medicare fee-for-service enrollment

Enrolled in OH

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

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 and National Provider Directory roles.

• Insight Counseling and Wellness LLC

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Mentor, OH
  • NPI 1255846952
  Medicare reassignment NPD

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

{
    "created_epoch": "1599696000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1724284800000",
    "number": "1902411630",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7519 MENTOR AVE STE 114",
            "city": "MENTOR",
            "state": "OH",
            "postal_code": "440605410",
            "telephone_number": "440-701-6170",
            "fax_number": "440-527-8043"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "398 W BAGLEY RD STE 13",
            "city": "BEREA",
            "state": "OH",
            "postal_code": "440171312",
            "telephone_number": "440-970-3790",
            "fax_number": "440-527-8043"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUSSO",
        "first_name": "NICOLE",
        "credential": "LISW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-09-10",
        "last_updated": "2024-08-22",
        "certification_date": "2024-08-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "OH",
            "license": "I.2405587",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0416980",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Tyler Rose
• Andre Ross, LPCC
• Heather Roth-Novak, CT
• Susan Diane Royer, LPTA
• Bridget Rubel, APRN, FNP-C
• Denise M Sadler, LISW-S
• Wilmary Saez, QMHS BA
• Noor Salam, PA-C
• Salina Salamah
• Germa Salem, LPN

• Clinical Social Worker in Berea, OH
• Providers in Berea, OH by specialty
• Clinical Social Worker in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2024; 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.