Individual
AMANDA LYNN RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW-C
Contact information
Practice address
29520 CANVASBACK DR, EASTON, MD 21601-7124
(410) 822-5007
Mailing address
8614 OCEAN GTWY, # 4, EASTON, MD 21601-7217
(410) 334-6961
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
16181
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
346646
MHN
MD
01
—
499188
VO-MHA
MD
01
—
522156095
AETNA
MD
05
—
609550002
—
MD
01
—
LM49EA
CAREFIRST BCBS
MD
01
—
R968
CAREFIRST BCBS - FEDERAL
MD
Enumeration date
08/17/2009
Last updated
04/25/2016
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