Provider Demographics
NPI:1700416005
Name:RUSSELL, CHRISTINA RACHELLE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTINA
Middle Name:RACHELLE
Last Name:RUSSELL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7116 CLINTON RD STE A
Mailing Address - Street 2:
Mailing Address - City:UPPER DARBY
Mailing Address - State:PA
Mailing Address - Zip Code:19082-5212
Mailing Address - Country:US
Mailing Address - Phone:856-629-0464
Mailing Address - Fax:
Practice Address - Street 1:7116 CLINTON RD STE A
Practice Address - Street 2:
Practice Address - City:UPPER DARBY
Practice Address - State:PA
Practice Address - Zip Code:19082-5212
Practice Address - Country:US
Practice Address - Phone:856-629-0464
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-25
Last Update Date:2022-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC060416001041C0700X
PACW0181681041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical