MEDICARE: RAMSAY LEIGH 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	091340	NY
2	1041C0700X	Clinical Social Worker	CW022405	PA
3	1041C0700X	Clinical Social Worker	44SC06053100	NJ
4	104100000X	Social Worker	102146	NY

General Provider Information

NPI Number	:	1487123527
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RAMSAY LEIGH RUSSELL LCSW

Provider Business Mailing Address
First Line	:	1030 CARROLL ST APT 5G
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11225-1949
Country	:	US
Telephone Number	:	315-427-5780
Fax Number	:

Provider Business Practice Location Address
First Line	:	466 LEXINGTON AVE
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10017-3140
Country	:	US
Telephone Number	:	646-988-1831
Fax Number	:

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

Provider Enumeration Date	:	11/19/2018
Last Update Date	:	12/27/2021

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