MEDICARE: CLAUDIA E 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

General Provider Information

NPI Number	:	1942666938
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CLAUDIA E RUSSELL LCSW

Provider Business Mailing Address
First Line	:	3450 NORTHLAKE BLVD STE 209
Second Line	:
City	:	PALM BEACH GARDENS
State	:	FL
Zip	:	33403-1713
Country	:	US
Telephone Number	:	561-900-4662
Fax Number	:

Provider Business Practice Location Address
First Line	:	3450 NORTHLAKE BLVD STE 209
Second Line	:
City	:	PALM BEACH GARDENS
State	:	FL
Zip	:	33403-1713
Country	:	US
Telephone Number	:	561-900-4662
Fax Number	:

Authorized Official
Title or Position	:	LICENSED CLINICAL SOCIAL WORKER
Name	:	MS. CLAUDIA E RUSSELL
Credential	:
Telephone Number	:	561-900-4662

Provider Enumeration Date	:	01/07/2016
Last Update Date	:	01/07/2016

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