Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Courtney Russo, LCSW

Individual provider Clinical Social Worker · NPI 1184188484

Courtney Russo, LCSW is a Clinical Social Worker in Coram, New York. Qualified in 2018, 8 years ago. Practices with Welllife Network Inc, a 17-clinician group. Licensed in New York.

Years since qualifying
8
Licensed in
NY
In the registry since
2019
What do these letters mean?
LCSW — Licensed Clinical Social Worker
A social worker licensed to diagnose and treat mental health conditions independently.

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Practice location Address checks out

3600 Route 112
Coram, NY 11727-4116
Phone: (631) 920-8675
Fax: (929) 244-4997
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Clinical Social Worker (primary) Taxonomy 1041C0700X · Licence 093492 (NY)

Record details

NPI number1184188484
Entity typeIndividual (Type 1)
GenderFemale
Credentials LCSW
Sole proprietorYes
NPI enumeratedJanuary 31, 2019
Last updated in NPPESMay 29, 2025
Certification dateMay 29, 2025

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyCLINICAL SOCIAL WORKER
Medical schoolOTHER
Graduated 2018 (8 years in practice)
Group practice Welllife Network Inc — 17 clinicians
Accepts Medicare assignment Not indicated

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