MEDICARE: MR. RUSSELL CARR LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	1863	NH

General Provider Information

NPI Number	:	1063302693
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. RUSSELL CARR LCSW

Provider Business Mailing Address
First Line	:	218 EAST RD
Second Line	:
City	:	HAMPSTEAD
State	:	NH
Zip	:	03841-5303
Country	:	US
Telephone Number	:	603-329-5311
Fax Number	:	603-329-5529

Provider Business Practice Location Address
First Line	:	218 EAST RD
Second Line	:
City	:	HAMPSTEAD
State	:	NH
Zip	:	03841-5303
Country	:	US
Telephone Number	:	603-329-5311
Fax Number	:	603-329-5529

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/07/2025
Last Update Date	:	07/31/2025

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