Individual
MS. BRANDY RUSSELL-MERVOSH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
901 S ROGERS ST, BLOOMINGTON, IN 47403-4760
(812) 323-9890
(812) 829-2596
Mailing address
PO BOX 599, SPENCER, IN 47460-0599
(812) 829-2526
(812) 829-2596
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
34002977A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000210144
BLUE SHIELD
IN
01
—
36295
CIGNA
IN
01
—
7157432
AETNA
IN
Enumeration date
02/01/2006
Last updated
02/17/2017
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