Individual
MERCY BURTON RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
835 SPRUCE ST STE C&D, ESPANOLA, NM 87532-3455
(505) 747-7400
(505) 443-8310
Mailing address
835 SPRUCE ST STE C&D, ESPANOLA, NM 87532-3455
(505) 747-7400
(505) 443-8310
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
19550
AZ
1041C0700X
Clinical Social Worker
89-0000212
VT
1041C0700X
Clinical Social Worker
Primary
SWB-2025-0022
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
821-8223
VERMONT BCBS PIN
VT
01
—
89-0000212
VERMONT LCSW
VT
Enumeration date
01/25/2007
Last updated
06/20/2025
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