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General NPI Number Information
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NPI Number | 1295944254
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Entity Type | Individual
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Provider Name | OLIVER RUSSELL LCSW-C
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Gender | Male
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Dates
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Enumeration Date | 05/22/2007
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Last Update Date | 01/08/2014
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Provider Practice Location Address
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Address Line | 1001 LAWRENCE ST NE
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City | WASHINGTON
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State | DC
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Zip | 20017-3513
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Country | US
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Telephone | 202-635-5990
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Fax |
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Provider Business Mailing Address
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Address Line | 210 W TAYLOR RUN PKWY
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City | ALEXANDRIA
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State | VA
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Zip | 22314-4932
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Country | US
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Telephone | 703-795-4920
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Fax |
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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 | 10749
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | LC3000796
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License Number State | DC
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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 0904005217
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License Number State | VA
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