Active NPI
Oliver Russell, LCSW-C
- Clinical Social Worker
- Washington, DC
National Provider Identifier
1295944254
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 10749
- Practice address
- 1001 Lawrence St NE
Washington, DC 20017-3513 - Phone
- (202) 635-5990
- NPI assigned
- May 22, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 10749 | MD | Primary |
| Clinical Social Worker | 1041C0700X | LC3000796 | DC | |
| Clinical Social Worker | 1041C0700X | 0904005217 | VA |
Addresses
Primary practice location
1001 Lawrence St NE
Washington, DC 20017-3513
Mailing address
210 W Taylor Run Pkwy
Alexandria, VA 22314-4932
Phone (703) 795-4920
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| LC30007976 | Medicaid | DC | |
| LCSW-C10749 | Medicaid | MD | |
| 0904005217 | Medicaid | VA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LC3000796 | DC | MD | Clinical Social Worker |
| 0904005217 | VA | MD | Clinical Social Worker |
| 10749 | MD | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1179792000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1389139200000",
"number": "1295944254",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "210 W TAYLOR RUN PKWY",
"city": "ALEXANDRIA",
"state": "VA",
"postal_code": "223144932",
"telephone_number": "703-795-4920"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1001 LAWRENCE ST NE",
"city": "WASHINGTON",
"state": "DC",
"postal_code": "200173513",
"telephone_number": "202-635-5990"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RUSSELL",
"first_name": "OLIVER",
"credential": "LCSW-C",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-05-22",
"last_updated": "2014-01-08",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "MD",
"license": "10749",
"primary": true
},
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "DC",
"license": "LC3000796",
"primary": false
},
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "VA",
"license": "0904005217",
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "LC30007976",
"state": "DC"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "LCSW-C10749",
"state": "MD"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0904005217",
"state": "VA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Washington, DC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 8, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.