MEDICARE: ZACHARY FARRINGTON RUSSELL 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	C019232	NC

General Provider Information

NPI Number	:	1154000511
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ZACHARY FARRINGTON RUSSELL LCSW

Provider Business Mailing Address
First Line	:	1441 E BROAD ST STE 127
Second Line	:
City	:	FUQUAY VARINA
State	:	NC
Zip	:	27526-1968
Country	:	US
Telephone Number	:	203-581-0920
Fax Number	:

Provider Business Practice Location Address
First Line	:	1903 N HARRISON AVE STE 100
Second Line	:
City	:	CARY
State	:	NC
Zip	:	27513-3003
Country	:	US
Telephone Number	:	203-581-0920
Fax Number	:

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

Provider Enumeration Date	:	07/13/2023
Last Update Date	:	11/07/2025

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