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DR. KELLY L RUSSO PH.D.
NPI 1265664734
Psychologist - Clinical in Orangeburg, SC

Active since August 18, 2009
1767 VILLAGE PARK DR, ORANGEBURG, SC 29118(803) 776-4000(803) 536-1719 Get Directions Write a Review

NPPES record last updated: May 1, 2014. Verified against the NPPES registry weekly; last sync: July 26, 2026.

About Dr. Kelly L Russo Ph.d. NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DR. KELLY L RUSSO PH.D. (NPI 1265664734) is an individual clinical provider in Orangeburg, South Carolina, licensed in Florida (PY-8336) and active in the NPI registry since August 2009.

NPPES Registry Identity

NPI1265664734
Entity TypeIndividualFemale
Primary Taxonomy103TC0700X
Provider Legal NameDR. KELLY L RUSSOCredential: PH.D.
Location Address1767 VILLAGE PARK DROrangeburg, SC 29118-2475
Mailing Address715 Darlington StColumbia, SC 29201-1201 · (239) 314-8511
Phone(803) 776-4000
Fax(803) 536-1719
Sole ProprietorYes
Enumeration DateAugust 18, 2009
Last NPPES UpdateMay 1, 2014
✔ NPI 1265664734 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPsychologist · ClinicalBehavioral Health & Social Service Providers
Taxonomy Code103TC0700X
License✔ Licensed in FL · PY-8336
Definition

A psychologist who provides continuing and comprehensive mental and behavioral health care for individuals and families; consultation to agencies and communities; training, education and supervision; and research-based practice. It is a specialty in breadth -- one that is broadly inclusive of severe psychopathology -- and marked by comprehensiveness and integration of knowledge and skill from a broad array of disciplines within and outside of psychology proper. The scope of clinical psychology encompasses all ages, multiple diversities and varied systems.

1767 VILLAGE PARK DR, Orangeburg, SC 29118
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Other Names 1

Former Name (1)Kelly L Davis

Other Identifiers 1

Medicaid54516ND

Other Providers at the Same Location NPPES 3

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

MS. JANET PAPARELLA ADAMS
Social Worker (Clinical)
1767 VILLAGE PARK DR
ORANGEBURG, SC 29118
Orangeburg County (803) 533-1335
RITA JONES ROBINSON MD
Internal Medicine
1767 VILLAGE PARK DR, VA OUTPATIENT CLINIC
ORANGEBURG, SC 29118
Orangeburg County (803) 533-5335
SINGLETON HEALTH CENTER LLC
Clinic/Center (Rural Health)
1767 VILLAGE PARK DR
ORANGEBURG, SC 29118
Orangeburg County (803) 535-3600

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Kelly Russo's NPI number?

The NPI number for Kelly Russo is 1265664734. It was assigned to this individual provider in the NPPES registry on August 18, 2009. The provider is also known as Kelly L Davis.

Where is Kelly Russo located?

Kelly Russo practices at 1767 Village Park Dr, Orangeburg, SC 29118. The listed phone number is (803) 776-4000.

What is Kelly Russo's specialty?

The primary specialty registered for this NPI is Psychologist, specializing in Clinical, with taxonomy code 103TC0700X.

When was this NPI record last updated?

The NPPES record for Kelly Russo was last updated on May 1, 2014. NPI Profile syncs with the weekly NPPES data releases published by CMS.