| Dr Kelly L Russo, PHD | |
|
1767 Village Park Dr, Orangeburg, SC 29118-2475 | |
| (803) 776-4000 | |
| (803) 536-1719 |
| Full Name | Dr Kelly L Russo |
|---|---|
| Gender | Female |
| Speciality | Psychologist - Clinical |
| Location | 1767 Village Park Dr, Orangeburg, South Carolina |
| Accepts Medicare Assignments | Does not participate in Medicare Program. She may not accept medicare assignment. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1265664734 | NPI | - | NPPES |
| 54516 | Medicaid | ND |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | PY-8336 (Florida) | Primary |
| Mailing Address | Practice Location Address |
|---|---|
| Dr Kelly L Russo, PHD 715 Darlington St, Columbia, SC 29201-1201 Ph: (239) 314-8511 | Dr Kelly L Russo, PHD 1767 Village Park Dr, Orangeburg, SC 29118-2475 Ph: (803) 776-4000 |
Dr. Valerie Louise Holmstrom, PHD Psychologist Medicare: Medicare Enrolled Practice Location: 1205 Hutto St, Orangeburg, SC 29118 Phone: 803-536-3100 Fax: 803-536-3100 | |
Dr. Reuben Benjamin Ridgeway, PHD Psychologist Medicare: Accepting Medicare Assignments Practice Location: 1175 Cook Rd Ste 305, Orangeburg, SC 29118 Phone: 803-395-3715 Fax: 803-395-3719 | |
Ms. Arnitha Butler, Psychologist Medicare: Not Enrolled in Medicare Practice Location: 392 Orangepark Dr, Orangeburg, SC 29115 Phone: 803-534-8866 Fax: 803-534-8866 |