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General NPI Number Information
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NPI Number | 1114730322
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Entity Type | Individual
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Provider Name | STEPHANIE RUSSELL
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Gender | Female
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Dates
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Enumeration Date | 01/30/2025
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Last Update Date | 03/11/2025
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Provider Practice Location Address
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Address Line | 3024 EASTON AVE
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City | BETHLEHEM
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State | PA
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Zip | 18017-4208
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Country | US
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Telephone | 610-694-1000
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Fax |
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Provider Business Mailing Address
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Address Line | 2100 MACK BLVD
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City | ALLENTOWN
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State | PA
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Zip | 18103-5622
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Country | US
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Telephone | 484-884-4500
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Fax | 484-884-0699
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | CW025430
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License Number State | PA
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