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NPI Code Detail

MEDICARE: CASEY LYNN RUSSELL CSC-AD

MEDICARE: CASEY LYNN RUSSELL CSC-AD
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
1101YA0400XAddiction (Substance Use Disorder) CounselorSC1605MD

Other Identifiers

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

General Provider Information

NPI Number : 1730456195
Entity Type Code : Individual
Provider Name (Legal Business Name) : CASEY LYNN RUSSELL CSC-AD
Provider Business Mailing Address
First Line : 1113 HEALTHWAY DR
Second Line :
City : SALISBURY
State : MD
Zip : 21804-4470
Country : US
Telephone Number : 410-334-6961
Fax Number : 410-334-6362
Provider Business Practice Location Address
First Line : 1113 HEALTHWAY DR
Second Line :
City : SALISBURY
State : MD
Zip : 21804-4470
Country : US
Telephone Number : 410-334-6961
Fax Number : 410-334-6362
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/29/2011
Last Update Date : 04/18/2018

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