Russo, Fred Cipriano

Russo, Fred Cipriano is an individual health care provider with primary practice located at 1023 Pulaski Road , East Northport NY 11731. He recently has only one registered license in Behavioral Health & Social Service Providers / Clinical, which is considered as his primary health care specialty. Russo, Fred Cipriano can be contacted via phone (631) 261-4296.

Contact Information

Primary practice address
1023 Pulaski Road East Northport NY 11731
Phone: (631) 261-4296
Fax: (631) 261-4296
Website:
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Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Clinical 1041C0700X R023424 New York

Profile Details

NPI number 1821144288
LBN Legal business name Russo, Fred Cipriano
Credentials Licensed Clinical Social Worker (LCSW)
Entity Individual
Sole proprietor 1 No
Enumeration date Jan 26th, 2007
Last updated Jul 8th, 2007 - about 19 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1821144288 NPPES
New York MEDICAID 01968423
New York Other 118060
New York Other 7400383

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