Provider Demographics
NPI:1154455491
Name:RUSSO, LORRAINE A (MS, CCC-A, FAAA)
Entity Type:Individual
Prefix:MS
First Name:LORRAINE
Middle Name:A
Last Name:RUSSO
Suffix:
Gender:F
Credentials:MS, CCC-A, FAAA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:61 LINCOLN ST
Mailing Address - Street 2:SUITE 207
Mailing Address - City:FRAMINGHAM
Mailing Address - State:MA
Mailing Address - Zip Code:01702-8264
Mailing Address - Country:US
Mailing Address - Phone:508-875-6124
Mailing Address - Fax:508-875-9349
Practice Address - Street 1:61 LINCOLN ST
Practice Address - Street 2:METROWEST ENT SUITE 207
Practice Address - City:FRAMINGHAM
Practice Address - State:MA
Practice Address - Zip Code:01702-8264
Practice Address - Country:US
Practice Address - Phone:508-875-6124
Practice Address - Fax:508-875-9349
Is Sole Proprietor?:No
Enumeration Date:2007-03-16
Last Update Date:2013-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA179231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
RU027964Medicare ID - Type Unspecified