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

Individual provider Clinical Child & Adolescent Psychologist · NPI 1962280024

Dr. Jaclyn Russo, PHD is a Clinical Child & Adolescent Psychologist in Charlotte, North Carolina. Practices as a sole proprietor. Licensed in North Carolina.

Licensed in
NC
In the registry since
2023
What do these letters mean?
PHD — Doctor of Philosophy
A research doctorate. In healthcare it usually sits alongside a clinical licence.

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Practice location Address checks out

4722 Park Rd Ste B
Charlotte, NC 28209-3802
Phone: (704) 665-7424
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Clinical Child & Adolescent Psychologist (primary) Taxonomy 103TC2200X · Licence 6402 (NC)

Record details

NPI number1962280024
Entity typeIndividual (Type 1)
GenderFemale
Credentials PHD
Sole proprietorYes
NPI enumeratedSeptember 20, 2023
Last updated in NPPESSeptember 20, 2023
Certification dateSeptember 20, 2023

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