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General NPI Number Information
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NPI Number | 1437650025
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Entity Type | Individual
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Provider Name | MRS. MONIQUE RUSSELL
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Gender | Female
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Dates
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Enumeration Date | 02/28/2018
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Last Update Date | 07/14/2025
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Provider Practice Location Address
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Address Line | 505 HAMPTON PARK BLVD STE Q
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City | CAPITOL HEIGHTS
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State | MD
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Zip | 20743-3862
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Country | US
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Telephone | 585-333-0299
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Fax |
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Provider Business Mailing Address
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Address Line | 75 WASHINGTON ST UNIT 516
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City | FAIRBURN
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State | GA
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Zip | 30213-3605
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Country | US
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Telephone | 585-333-0299
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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 | 29801
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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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 | 099073
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License Number State | NY
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Taxonomy #4
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 109638
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License Number State |
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Taxonomy #5
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | CSW009661
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License Number State | GA
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