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NPI Code Detail

MEDICARE: CAREY RUSS LCSW

MEDICARE:   CAREY  RUSS  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
11041C0700XClinical Social Worker149.012275IL

General Provider Information

NPI Number : 1982863916
Entity Type Code : Individual
Provider Name (Legal Business Name) : CAREY RUSS LCSW
Provider Business Mailing Address
First Line : 167 N SIGNAL HILL RD
Second Line :
City : NORTH BARRINGTON
State : IL
Zip : 60010-1928
Country : US
Telephone Number : 773-459-5892
Fax Number :
Provider Business Practice Location Address
First Line : 167 N SIGNAL HILL RD
Second Line :
City : NORTH BARRINGTON
State : IL
Zip : 60010-1928
Country : US
Telephone Number : 773-459-5892
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/05/2008
Last Update Date : 06/05/2008

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Directions to “ CAREY RUSS LCSW” Practice Location

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