Provider Demographics
NPI:1699294371
Name:RUSSELLO, BETH
Entity type:Individual
Prefix:
First Name:BETH
Middle Name:
Last Name:RUSSELLO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:610 TEN ROD RD UNIT 5
Mailing Address - Street 2:
Mailing Address - City:NORTH KINGSTOWN
Mailing Address - State:RI
Mailing Address - Zip Code:02852-4206
Mailing Address - Country:US
Mailing Address - Phone:401-410-1776
Mailing Address - Fax:
Practice Address - Street 1:610 TEN ROD RD UNIT 5
Practice Address - Street 2:
Practice Address - City:NORTH KINGSTOWN
Practice Address - State:RI
Practice Address - Zip Code:02852-4206
Practice Address - Country:US
Practice Address - Phone:401-410-1776
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-14
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator