Provider Demographics
NPI:1306162052
Name:RUSSO, ELIZABETH M (LCSW-R)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:M
Last Name:RUSSO
Suffix:
Gender:F
Credentials:LCSW-R
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:
Other - Last Name:DELGAUDIO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1311 UNION ST.
Mailing Address - Street 2:
Mailing Address - City:SCHENECTADY
Mailing Address - State:NY
Mailing Address - Zip Code:12308
Mailing Address - Country:US
Mailing Address - Phone:518-374-6263
Mailing Address - Fax:518-374-1778
Practice Address - Street 1:1311 UNION ST
Practice Address - Street 2:
Practice Address - City:SCHENECTADY
Practice Address - State:NY
Practice Address - Zip Code:12308-2905
Practice Address - Country:US
Practice Address - Phone:518-374-6263
Practice Address - Fax:518-374-1778
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-19
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0417981041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical