Individual provider · Type 1 NPI
Kellie Marie Russo, CASAC-2
Addiction (Substance Use Disorder) Counselor · Staten Island, NY
NPI number
1548825151
Active
Practice location
460 Brielle Ave
Staten Island, NY 10314-6427
Fax (718) 356-3155
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Addiction (Substance Use Disorder) Counselor Primary | 101YA0400X | 29679 (NY) |
Addiction (Substance Use Disorder) Counselor: Definition to come...
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About NPI 1548825151
Kellie Marie Russo, CASAC-2's National Provider Identifier is 1548825151, issued on May 8, 2019. The primary taxonomy on file is Addiction (Substance Use Disorder) Counselor (101YA0400X), and the practice location is in Staten Island, NY. The record was last updated on May 8, 2019.