| Doctor Name: | ANGELA RUSSO |
| NPI Number: | 1770828469 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | LCPC, CADC |
| License Number: | CAC4911 |
| Business Practice Address: | 14 Main Street Mars Hill, ME - 04758 |
| Business Phone Number: | 2074253880 |
| Business Fax Number: | |
| Mailing Address: | 378 Development Dr, LIMESTONE |
| State: | ME |
| Postal Code: | 047506128 |
| Phone Number: | 3035204618 |
| Fax Number: | |
| NPI Enumeration Date: | 12/06/2012 |
| NPI Last Update Date: | 12/06/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YA0400X |
| License Number: | CAC4911 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | ME |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Addiction (Substance Use Disorder) |
| Taxonomy Definition: | |