Active NPI
George Russell, LCSW
- Clinical Social Worker
- Bangor, ME
National Provider Identifier
1316182546
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- LC7659
- Practice address
- 77 Court St
Bangor, ME 04401-4723 - Phone
- (207) 941-0879
- Fax
- (207) 941-0880
- NPI assigned
- Dec 2, 2008
- Last updated
- Dec 2, 2008
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | LC7659 | ME | Primary |
Addresses
Primary practice location
77 Court St
Bangor, ME 04401-4723
Mailing address
77 Court St
Bangor, ME 04401-4723
Phone (207) 941-0879
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 423840099 | Medicaid | ME |
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
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Common Ground Friends | Current | Accepting new patients | |
| Behavioral Health Center | Clinical | Past | Accepting new patients |
| Full Circle Wellness Center, Inc. | Clinical | Past | Accepting new patients |
| Knada, PA | Clinical | Past | Accepting new patients |
Locations
304 Hancock St
Ste 3B
Bangor, ME 04401
Phone (207) 990-3626
Organizations & group practices 4
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Public Health or Welfare Agency
- Bangor, ME
- NPI 1265283006
-
- Clinical Social Worker
- Bangor, ME
- NPI 1346333838
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1228176000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1228176000000",
"number": "1316182546",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "77 COURT ST",
"city": "BANGOR",
"state": "ME",
"postal_code": "044014723",
"telephone_number": "207-941-0879",
"fax_number": "207-941-0880"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "77 COURT ST",
"city": "BANGOR",
"state": "ME",
"postal_code": "044014723",
"telephone_number": "207-941-0879",
"fax_number": "207-941-0880"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RUSSELL",
"first_name": "GEORGE",
"credential": "LCSW",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2008-12-02",
"last_updated": "2008-12-02",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "ME",
"license": "LC7659",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "423840099",
"state": "ME"
}
],
"endpoints": [],
"other_names": []
}Other providers in Bangor, ME
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 2, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.