Healthcare Provider Details

I. General information

NPI: 1578768651
Provider Name (Legal Business Name): CLAUDIA E RUSSELL LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/18/2007
Last Update Date: 06/16/2025
Certification Date: 06/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1710 E TIFFANY DR STE 321
MANGONIA PARK FL
33407-3242
US

IV. Provider business mailing address

PO BOX 8362
WEST PALM BEACH FL
33407-0362
US

V. Phone/Fax

Practice location:
  • Phone: 561-900-4662
  • Fax: 561-257-1231
Mailing address:
  • Phone: 561-900-4662
  • Fax: 561-257-1231

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW8389
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: