Amanda Louise Russell, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

LCSW-38205 Issued in ID

Practice address

1218 N Division Ave Ste 217
Sandpoint, ID 83864-5054

Phone

(208) 610-6459

Fax

(208) 694-2139

NPI assigned

Oct 12, 2016

Last updated

Mar 5, 2024By the provider in NPPES

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 ID

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, 2016

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Fusion Care Group a Psychological Professional CorporationGroup PAC ID 8921433590, 45 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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Fusion Care Group, a Psychological Professional Corporation

  • Clinical Psychologist
  • Alpine, CA
  • NPI 1275177982

  ID

  Medicare reassignment Care Compare group NPD
• Haven Mental Wellness LLC

  • Clinical Social Worker
  • Sandpoint, ID
  • NPI 1497620116
  NPD Authorized official

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

{
    "created_epoch": "1476230400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1709596800000",
    "number": "1851841969",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1317 PROMINENCE CT",
            "city": "SANDPOINT",
            "state": "ID",
            "postal_code": "838645412",
            "telephone_number": "208-610-6459",
            "fax_number": "208-694-2139"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1218 N DIVISION AVE STE 217",
            "city": "SANDPOINT",
            "state": "ID",
            "postal_code": "838645054",
            "telephone_number": "208-610-6459",
            "fax_number": "208-694-2139"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUSSELL",
        "first_name": "AMANDA",
        "middle_name": "LOUISE",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-10-12",
        "last_updated": "2024-03-05",
        "certification_date": "2024-03-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "ID",
            "license": "LMSW36080",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "ID",
            "license": "LCSW-38205",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Cynthia Denise Ruguleiski, LCSW
• Dante Sandro Rumore, LICSW
• Paul Gerald Rumore, M.D.
• Rurban PLLC (Rurban Health)
• Rhonda Russ, LMT
• Nicole Elizabeth Russell, MD
• Paige Tara Russell, DNP, NP-C
• Christina Marie Rust, DPT, PA-C
• Robert Edward Rust Jr., M.D.
• Kimberly Amelia Rutland, WHNP

• Clinical Social Worker in Sandpoint, ID
• Providers in Sandpoint, ID by specialty
• Clinical Social Worker in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 5, 2024; 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.