Provider Demographics
NPI:1225550676
Name:RUSSELL, STEPHEN SHANE (LCSW)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:SHANE
Last Name:RUSSELL
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 E NORTH ST
Mailing Address - Street 2:
Mailing Address - City:CARLISLE
Mailing Address - State:PA
Mailing Address - Zip Code:17013-2429
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:717-620-0536
Practice Address - Street 1:25 E NORTH ST
Practice Address - Street 2:
Practice Address - City:CARLISLE
Practice Address - State:PA
Practice Address - Zip Code:17013-2429
Practice Address - Country:US
Practice Address - Phone:717-422-6440
Practice Address - Fax:717-620-0536
Is Sole Proprietor?:No
Enumeration Date:2017-07-07
Last Update Date:2021-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0214981041C0700X
PASW134255104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical