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NPI Code Detail

MEDICARE: JOHN RUSSUM LCSW

MEDICARE: JOHN RUSSUM 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
11041C0700XClinical Social WorkerQ10000855DE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1Q10000855OTHERDECLINICAL LICENSE

General Provider Information

NPI Number : 1407961022
Entity Type Code : Individual
Provider Name (Legal Business Name) : JOHN RUSSUM LCSW
Provider Business Mailing Address
First Line : 21444 CARMEAN WAY
Second Line :
City : GEORGETOWN
State : DE
Zip : 19947-4572
Country : US
Telephone Number : 302-855-1233
Fax Number :
Provider Business Practice Location Address
First Line : 21444 CARMEAN WAY
Second Line :
City : GEORGETOWN
State : DE
Zip : 19947-4572
Country : US
Telephone Number : 302-855-1233
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/21/2006
Last Update Date : 09/10/2025

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