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DR. JACLYN RUSSO PHD NPI 1962280024


NPI Information

NPI: 1962280024
Provider Name: DR. JACLYN RUSSO, PHD
Classification: Psychologist - 103TC2200X
Entity Type: Individual

Specialization: Clinical Child & Adolescent

Address:
4722 PARK RD STE B
CHARLOTTE, NC
ZIP 28209
Phone: (704) 665-7424
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DR. Jaclyn Russo, PHD is a clinical child and adolescent psychologist in Charlotte, NC. The provider is a psychologist who develops and applies scientific knowledge to the delivery of psychological services to infants, toddlers, children and adolescents within their social context. Of particular importance to the specialty of clinical child psychology is an understanding of the basic psychological needs of children and adolescents, and how the family and other social contexts influence the socio-emotional adjustment, cognitive development, behavioral adaptation and health status of children and adolescents. DR. Jaclyn Russo, PHD NPI is 1962280024. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

The provider's business location address is:

4722 PARK RD STE B
CHARLOTTE, NC
ZIP 28209-802
Phone: (704) 665-7424

The enumeration date for this NPI number is 9/20/2023 and was last updated on 9/20/2023.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1103TC2200XPsychologistClinical Child & Adolescent6402NORTH CAROLINAYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

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