Provider Demographics
NPI:1992298848
Name:RUSSO, KARINA (KARINA)
Entity type:Individual
Prefix:
First Name:KARINA
Middle Name:
Last Name:RUSSO
Suffix:
Gender:F
Credentials:KARINA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 FIELDCREST RD
Mailing Address - Street 2:
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10707-1009
Mailing Address - Country:US
Mailing Address - Phone:845-531-1209
Mailing Address - Fax:
Practice Address - Street 1:963 SCARSDALE RD
Practice Address - Street 2:
Practice Address - City:SCARSDALE
Practice Address - State:NY
Practice Address - Zip Code:10583-4852
Practice Address - Country:US
Practice Address - Phone:914-810-2237
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-14
Last Update Date:2023-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0256-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist