Dr Jaclyn Russo, PHD - Psychologist in Charlotte, NC

Dr Jaclyn Russo, PHD is a Psychologist - Clinical Child & Adolescent based in Charlotte, North Carolina. Dr Jaclyn Russo is licensed to practice in North Carolina (license number 6402) and her current practice location is 4722 Park Rd Ste B, Charlotte, North Carolina. She can be reached at her office (for appointments etc.) via phone at (704) 665-7424.

NPI number for Dr Jaclyn Russo is 1962280024 and her current mailing address is 4722 Park Rd Ste B, Charlotte, North Carolina. She does not participate in medicare program and thus does not accept medicare assignments. Her NPI Number is 1962280024.

Contact Information

Dr Jaclyn Russo, PHD
4722 Park Rd Ste B,
Charlotte, NC 28209-3802
(704) 665-7424
Not Available

Map and Direction




Healthcare Provider's Profile

Full NameDr Jaclyn Russo
GenderFemale
SpecialityPsychologist - Clinical Child & Adolescent
Location4722 Park Rd Ste B, Charlotte, North Carolina
Accepts Medicare AssignmentsDoes not participate in Medicare Program. She may not accept medicare assignment.
  NPI Data:
  • NPI Number: 1962280024
  • Provider Enumeration Date: 09/20/2023
  • Last Update Date: 09/20/2023

Medical Identifiers

Medical identifiers for Dr Jaclyn Russo such as npi, medicare ID, medicare PIN, medicaid, etc.
IdentifierTypeStateIssuer
1962280024NPI-NPPES

Medical Taxonomies and Licenses

TaxonomyTypeLicense (State)Status
103TC2200XPsychologist - Clinical Child & Adolescent 6402 (North Carolina)Primary

Medicare Part D Prescriber Enrollment

Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Dr Jaclyn Russo is NOT enrolled with medicare and thus cannot prescribe medicare part D drugs to patients with medicare part D benefits.

Mailing Address and Practice Location

Mailing AddressPractice Location Address
Dr Jaclyn Russo, PHD
4722 Park Rd Ste B,
Charlotte, NC 28209-3802

Ph: (704) 665-7424
Dr Jaclyn Russo, PHD
4722 Park Rd Ste B,
Charlotte, NC 28209-3802

Ph: (704) 665-7424

Reviews and Comments


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