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NPI Code Detail

MEDICARE: EMILY RUSSELL PSYD

MEDICARE: EMILY RUSSELL PSYD
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
1103TC0700XClinical Psychologist07181MD
2103T00000XPsychologist0810007128VA

General Provider Information

NPI Number : 1457825945
Entity Type Code : Individual
Provider Name (Legal Business Name) : EMILY RUSSELL PSYD
Provider Business Mailing Address
First Line : 249 HENDERSON AVE
Second Line :
City : CUMBERLAND
State : MD
Zip : 21502-1638
Country : US
Telephone Number : 240-362-7444
Fax Number :
Provider Business Practice Location Address
First Line : 249 HENDERSON AVE
Second Line :
City : CUMBERLAND
State : MD
Zip : 21502-1638
Country : US
Telephone Number : 240-362-7444
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/17/2019
Last Update Date : 03/08/2024

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Directions to “ EMILY RUSSELL PSYD” Practice Location

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