Russo, Jaclyn
Russo, Jaclyn is an sole proprietor health care provider with primary practice located at 4722 Park Rd Ste B , Charlotte NC 28209-3802. She recently has only one registered license in Behavioral Health & Social Service Providers / Clinical Child & Adolescent, which is considered as her primary health care specialty. Russo, Jaclyn can be contacted via phone (704) 665-7424.Contact Information
Primary practice address
4722 Park Rd Ste B
Charlotte NC 28209-3802
Phone: (704) 665-7424
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Behavioral Health & Social Service Providers / Clinical Child & Adolescent | 103TC2200X | 6402 | North Carolina |
Profile Details
| NPI number | 1962280024 |
|---|---|
| LBN Legal business name | Russo, Jaclyn |
| Credentials | PHD |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Sep 20th, 2023 |
| Last updated | Sep 20th, 2023 - about 2 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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