MEDICARE: ELIZABETH RUSSELL

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	101YM0800X	Mental Health Counselor	CW025432	PA

General Provider Information

NPI Number	:	1740138494
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH RUSSELL

Provider Business Mailing Address
First Line	:	808 W 3RD ST
Second Line	:
City	:	LANSDALE
State	:	PA
Zip	:	19446-2121
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	252 W SWAMP RD STE 36
Second Line	:
City	:	DOYLESTOWN
State	:	PA
Zip	:	18901-2465
Country	:	US
Telephone Number	:	267-454-2028
Fax Number	:

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

Provider Enumeration Date	:	03/18/2026
Last Update Date	:	03/18/2026

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