Healthcare Provider Details

I. General information

NPI: 1396715637
Provider Name (Legal Business Name): RUSSELL W CARRINGTON LCSW C
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/26/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

975 N SOLOMONS ISLAND ROAD
PRINCE FREDERICK MD
20678
US

IV. Provider business mailing address

975 N SOLOMONS ISLAND ROAD PO BOX 980
PRINCE FREDERICK MD
20678
US

V. Phone/Fax

Practice location:
  • Phone: 410-535-5400
  • Fax: 410-414-9413
Mailing address:
  • Phone: 410-535-5400
  • Fax: 410-414-9413

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number06474
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: