Brandy Russell-Mervosh, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

34002977A Issued in IN

Practice address

901 S Rogers St
Bloomington, IN 47403-4760

Phone

(812) 323-9890

Fax

(812) 829-2596

NPI assigned

Feb 1, 2006

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1138752000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1487289600000",
    "number": "1275504623",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 599",
            "city": "SPENCER",
            "state": "IN",
            "postal_code": "474600599",
            "telephone_number": "812-829-2526",
            "fax_number": "812-829-2596"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "901 S ROGERS ST",
            "city": "BLOOMINGTON",
            "state": "IN",
            "postal_code": "474034760",
            "telephone_number": "812-323-9890",
            "fax_number": "812-829-2596"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUSSELL-MERVOSH",
        "first_name": "BRANDY",
        "name_prefix": "Ms.",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-02-01",
        "last_updated": "2017-02-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IN",
            "license": "34002977A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "7157432",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA",
            "identifier": "36295",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "000000210144",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Alyah Rupley, RBT
• Beth Conrad Rupp, MD
• William Parker Rusche, M.D.
• Laurie Rushlow, PSY.D.
• Michelle Rushton Perry, MSW
• Brittany Russell
• Haleigh Michelle Russell
• Laura Russell, MT-BC
• Bree Nicole Russo, MSW, LCSW
• Brandon Allen Rutherford, RBT

• Clinical Social Worker in Bloomington, IN
• Providers in Bloomington, IN by specialty
• Clinical Social Worker in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 17, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.