MEDICARE: MR. PAUL RUSSELL MSW, LISW

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	I.1440417	OH
2	104100000X	Social Worker	I.1440417	OH

General Provider Information

NPI Number	:	1548674088
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. PAUL RUSSELL MSW, LISW

Provider Business Mailing Address
First Line	:	10330 BROOKSIDE DR
Second Line	:
City	:	PERRYSBURG
State	:	OH
Zip	:	43551-7224
Country	:	US
Telephone Number	:	419-973-0842
Fax Number	:

Provider Business Practice Location Address
First Line	:	10330 BROOKSIDE DR
Second Line	:
City	:	PERRYSBURG
State	:	OH
Zip	:	43551-7224
Country	:	US
Telephone Number	:	419-973-0842
Fax Number	:

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

Provider Enumeration Date	:	06/12/2014
Last Update Date	:	02/23/2026

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