DR. JACLYN RUSSO PHD
NPI 1962280024
Psychologist - Clinical Child & Adolescent in Charlotte, NC

Q: What is Jaclyn Russo's NPI number?

The NPI number for Jaclyn Russo is 1962280024. It was assigned to this individual provider in the NPPES registry on September 20, 2023.

Q: What is Jaclyn Russo's specialty?

The primary specialty registered for this NPI is Psychologist, specializing in Clinical Child & Adolescent, with taxonomy code 103TC2200X.

Q: When was this NPI record last updated?

The NPPES record for Jaclyn Russo was last updated on September 20, 2023. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.

Active since September 20, 2023

4722 PARK RD STE B, CHARLOTTE, NC 28209(704) 665-7424 Get Directions Write a Review

NPPES record last updated: September 20, 2023. Verified against the NPPES registry weekly; last sync: August 16, 2026.

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About Dr. Jaclyn Russo Phd NPPES

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

DR. JACLYN RUSSO PHD (NPI 1962280024) is an individual clinical child & adolescent provider in Charlotte, North Carolina, licensed in North Carolina (6402) and active in the NPI registry since September 2023.

NPPES Registry Identity

NPI1962280024

Entity TypeIndividualFemale

Primary Taxonomy103TC2200X

Provider Legal NameDR. JACLYN RUSSOCredential: PHD

Location Address4722 PARK RD STE BCharlotte, NC 28209-3802

Mailing Address4722 Park Rd Ste BCharlotte, NC 28209-3802 · (704) 665-7424

Phone(704) 665-7424

Sole ProprietorYes

Enumeration DateSeptember 20, 2023

NPPES CertifiedSeptember 20, 2023

✔ NPI 1962280024 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPsychologist · Clinical Child & AdolescentBehavioral Health & Social Service Providers

Taxonomy Code103TC2200X

License✔ Licensed in NC · 6402

Definition

A psychologist who develops and applies scientific knowledge to the delivery of psychological services to infants, toddlers, children and adolescents within their social context. Of particular importance to the specialty of clinical child psychology is an understanding of the basic psychological needs of children and adolescents, and how the family and other social contexts influence the socio-emotional adjustment, cognitive development, behavioral adaptation and health status of children and adolescents.

4722 PARK RD STE B, Charlotte, NC 28209

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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 Jaclyn Russo's NPI number?

The NPI number for Jaclyn Russo is 1962280024. It was assigned to this individual provider in the NPPES registry on September 20, 2023.

Where is Jaclyn Russo located?

Jaclyn Russo practices at 4722 Park Rd Ste B, Charlotte, NC 28209. The listed phone number is (704) 665-7424.

What is Jaclyn Russo's specialty?

The primary specialty registered for this NPI is Psychologist, specializing in Clinical Child & Adolescent, with taxonomy code 103TC2200X.

When was this NPI record last updated?

The NPPES record for Jaclyn Russo was last updated on September 20, 2023. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.