Provider Demographics
NPI:1841369972
Name:DICK, RUSSELL ALAN (MSW LCSW C)
Entity type:Individual
Prefix:MR
First Name:RUSSELL
Middle Name:ALAN
Last Name:DICK
Suffix:
Gender:M
Credentials:MSW LCSW C
Other - Prefix:
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Other - Middle Name:
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Mailing Address - Street 1:40 SOUTH CHURCH STREET
Mailing Address - Street 2:SUITE 105
Mailing Address - City:WESTMINSTER
Mailing Address - State:MD
Mailing Address - Zip Code:21157-5414
Mailing Address - Country:US
Mailing Address - Phone:410-848-9244
Mailing Address - Fax:410-876-5042
Practice Address - Street 1:40 SOUTH CHURCH STREET
Practice Address - Street 2:SUITE 105
Practice Address - City:WESTMINSTER
Practice Address - State:MD
Practice Address - Zip Code:21157-5414
Practice Address - Country:US
Practice Address - Phone:410-848-9244
Practice Address - Fax:410-876-5042
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MD028711041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
QY39Medicare ID - Type Unspecified