Provider Demographics
NPI:1073726709
Name:CLARKE, RUSSHELE (LICSW)
Entity Type:Individual
Prefix:MRS
First Name:RUSSHELE
Middle Name:
Last Name:CLARKE
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5038 HIL MAR DR
Mailing Address - Street 2:
Mailing Address - City:FORESTVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20747-3841
Mailing Address - Country:US
Mailing Address - Phone:301-568-7376
Mailing Address - Fax:
Practice Address - Street 1:3230 PENNSYLVANIA AVE SE
Practice Address - Street 2:STE 213
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20020-3722
Practice Address - Country:US
Practice Address - Phone:202-583-1181
Practice Address - Fax:202-583-1189
Is Sole Proprietor?:No
Enumeration Date:2007-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLC30007641041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC305806OtherAMERIGROUP