MEDICARE: MR. PATRICK 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	TPSW6344	FL
2	1041C0700X	Clinical Social Worker	CSW.09930798	CO

General Provider Information

NPI Number	:	1942180849
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. PATRICK RUSSELL LCSW

Provider Business Mailing Address
First Line	:	1335 HORIZON LN
Second Line	:
City	:	LONGMONT
State	:	CO
Zip	:	80501-1004
Country	:	US
Telephone Number	:	720-915-8899
Fax Number	:

Provider Business Practice Location Address
First Line	:	1335 HORIZON LN
Second Line	:
City	:	LONGMONT
State	:	CO
Zip	:	80501-1004
Country	:	US
Telephone Number	:	720-915-8899
Fax Number	:

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

Provider Enumeration Date	:	09/03/2025
Last Update Date	:	03/18/2026

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