Active NPI
Robert L Russell, PHD
- Psychologist
- Milwaukee, WI
National Provider Identifier
1922050608
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- 2428
- Practice address
- 1000 N 92ND St
Child Development Center of CHW
Milwaukee, WI 53226-3533 - Phone
- (414) 805-3666
- NPI assigned
- May 17, 2006
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Psychologist | 103T00000X | 2428 | WI | Primary |
Addresses
Primary practice location
1000 N 92ND St
Child Development Center of CHW
Milwaukee, WI 53226-3533
Mailing address
1000 N 92ND St
Child Development Center of CHW
Milwaukee, WI 53226-3533
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 39139800 | Medicaid | WI |
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
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2428 | WI | MD | Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1147824000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1922050608",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1000 N 92ND ST",
"address_2": "CHILD DEVELOPMENT CENTER OF CHW",
"city": "MILWAUKEE",
"state": "WI",
"postal_code": "532263533"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1000 N 92ND ST",
"address_2": "CHILD DEVELOPMENT CENTER OF CHW",
"city": "MILWAUKEE",
"state": "WI",
"postal_code": "532263533",
"telephone_number": "414-805-3666"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RUSSELL",
"first_name": "ROBERT",
"middle_name": "L",
"name_prefix": "Ms.",
"credential": "PHD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-05-17",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "WI",
"license": "2428",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "39139800",
"state": "WI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Milwaukee, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.