| Doctor Name: | JOHN WALTER RUSSO |
| NPI Number: | 1174646426 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | LCSWR |
| License Number: | 059845-1 |
| Business Practice Address: | 70 W 11th St Suite 1e New York City, NY - 10011 |
| Business Phone Number: | 2122607966 |
| Business Fax Number: | |
| Mailing Address: | 70 West 11th St, Suite 1e NEW YORK CITY |
| State: | NY |
| Postal Code: | 10011 |
| Phone Number: | 2122607966 |
| Fax Number: | |
| NPI Enumeration Date: | 04/09/2007 |
| NPI Last Update Date: | 09/05/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1041C0700X |
| License Number: | 059845-1 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | NY |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Social Worker |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | A social worker who holds a master |