Healthcare Provider Details

I. General information

NPI: 1902144066
Provider Name (Legal Business Name): AMANDA CHRISTINE RUSSELL MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMANDA CHRISTINE RUSSELL MSW

II. Dates (important events)

Enumeration Date: 01/24/2013
Last Update Date: 11/07/2025
Certification Date: 11/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1951 NW 7TH AVE FL 3
MIAMI FL
33136-1104
US

IV. Provider business mailing address

1951 NW 7TH AVE FL 3
MIAMI FL
33136-1104
US

V. Phone/Fax

Practice location:
  • Phone: 305-902-6347
  • Fax:
Mailing address:
  • Phone: 305-902-6347
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number34010679A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: