MEDICARE: DR. TERESA MARIE RUSSELL PSYD, LCPC, LCADC

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	101YP2500X	Professional Counselor	LC5788	MD
2	101YP2500X	Professional Counselor	TPMC80	FL
3	101Y00000X	Counselor	CP000009	NV
4	101YP2500X	Professional Counselor	CP000009	NV
5	101YP2500X	Professional Counselor	MHC863	HI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1134171945
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TERESA MARIE RUSSELL PSYD, LCPC, LCADC

Provider Business Mailing Address
First Line	:	10299 REINDEER PL
Second Line	:
City	:	NEW MARKET
State	:	MD
Zip	:	21774-6818
Country	:	US
Telephone Number	:	240-575-1206
Fax Number	:

Provider Business Practice Location Address
First Line	:	10299 REINDEER PL
Second Line	:
City	:	NEW MARKET
State	:	MD
Zip	:	21774-6818
Country	:	US
Telephone Number	:	240-575-1206
Fax Number	:

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

Provider Enumeration Date	:	05/17/2006
Last Update Date	:	04/30/2025

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