Provider Demographics
NPI:1861911711
Name:RUSSOLELLO, MARGARITA (DACM, LAC)
Entity type:Individual
Prefix:DR
First Name:MARGARITA
Middle Name:
Last Name:RUSSOLELLO
Suffix:
Gender:F
Credentials:DACM, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:861 PARK PL
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11216-4003
Mailing Address - Country:US
Mailing Address - Phone:845-235-3862
Mailing Address - Fax:
Practice Address - Street 1:15 W 28TH ST STE 5R
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-6410
Practice Address - Country:US
Practice Address - Phone:845-235-3862
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-12
Last Update Date:2024-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171400000X, 374J00000X
NY006638171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula
No171400000XOther Service ProvidersHealth & Wellness Coach
Yes171100000XOther Service ProvidersAcupuncturist