Theresa Russell, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

SW12181 Issued in FL

Practice address

350 N Federal Hwy
715
Boynton Beach, FL 33435-4171

Phone

(631) 793-1365

NPI assigned

Mar 27, 2017

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in FL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Social Worker

Education

Other, 1996

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Senior Living Memory Health IncGroup PAC ID 7517480577, 113 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Senior Living Memory Health, Inc.

  dba Memory Training Centers of Florida

  • Clinical Psychologist
  • North Miami Beach, FL
  • NPI 1851847834
  Medicare reassignment Care Compare group NPD
• Mtca Psychological Services P.a.

  • Clinical Psychologist
  • North Miami Beach, FL
  • NPI 1740552322
  Medicare reassignment NPD

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

{
    "created_epoch": "1490572800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1490572800000",
    "number": "1295266674",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "350 N FEDERAL HWY",
            "address_2": "715",
            "city": "BOYNTON BEACH",
            "state": "FL",
            "postal_code": "334354171",
            "telephone_number": "631-793-1365"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "350 N FEDERAL HWY",
            "address_2": "715",
            "city": "BOYNTON BEACH",
            "state": "FL",
            "postal_code": "334354171",
            "telephone_number": "631-793-1365"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUSSELL",
        "first_name": "THERESA",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2017-03-27",
        "last_updated": "2017-03-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "FL",
            "license": "SW12181",
            "primary": true
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NY",
            "license": "R053958-1",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jhunior Ruisanchez Escarra
• Marisol Ruiz Ahumada, DC
• Naomi Ruiz Coffat
• Tierra Tyniece Rushing, LCSW
• Katherine Rusnak, CRNA
• Jacqueline Russo, DDS
• Rustic Retreat Florida LLC
• Kyle Scott Rutledge, ATC
• RWC Health Holdings, LLC.
• RWW Senior Living Outpatient Rehab Services, LLC (Adoration Outpatient Therapy)

• Clinical Social Worker in Boynton Beach, FL
• Providers in Boynton Beach, FL by specialty
• Clinical Social Worker in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 27, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.