MEDICARE: MS. TERRI ANN RUSSELL LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	0904004959	VA

General Provider Information

NPI Number	:	1063918019
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. TERRI ANN RUSSELL LCSW

Provider Business Mailing Address
First Line	:	PO BOX 23120
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23223-0420
Country	:	US
Telephone Number	:	804-343-6500
Fax Number	:

Provider Business Practice Location Address
First Line	:	HENRICO COUNTY PUBLIC SCHOOLS
Second Line	:	3820 NINE MILE RD.
City	:	HENRICO
State	:	VA
Zip	:	23223
Country	:	US
Telephone Number	:	804-343-6500
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/30/2018
Last Update Date	:	06/20/2025

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