Provider Demographics
NPI:1326846825
Name:JOHN MICHAEL RUSSO
Entity type:Organization
Organization Name:JOHN MICHAEL RUSSO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:RUSSO
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:412-515-5746
Mailing Address - Street 1:111 N PARK ST
Mailing Address - Street 2:
Mailing Address - City:MONROEVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15146-4013
Mailing Address - Country:US
Mailing Address - Phone:412-515-5746
Mailing Address - Fax:
Practice Address - Street 1:6315 FORBES AVE STE 125C
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15217-1745
Practice Address - Country:US
Practice Address - Phone:412-515-5746
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-03
Last Update Date:2025-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty