Basic Information
| Provider Information | |||||||||
| NPI: | 1427280072 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RUSSELL | ||||||||
| FirstName: | AMANDA | ||||||||
| MiddleName: | LYNN | ||||||||
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| Credential: | LCSW-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8614 OCEAN GTWY | ||||||||
| Address2: | # 4 | ||||||||
| City: | EASTON | ||||||||
| State: | MD | ||||||||
| PostalCode: | 216017217 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4103346961 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 29520 CANVASBACK DR | ||||||||
| Address2: | |||||||||
| City: | EASTON | ||||||||
| State: | MD | ||||||||
| PostalCode: | 216017124 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4108225007 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/17/2009 | ||||||||
| LastUpdateDate: | 04/25/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 16181 | MD | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
ID Information
| ID | Type | State | Issuer | Description | 522156095 | 01 | MD | AETNA | OTHER | 522156095 | 01 | MD | UNITEDE HEALTH CARE | OTHER | R968 | 01 | MD | CAREFIRST BCBS - FEDERAL | OTHER | 522156095 | 01 | MD | MHNET | OTHER | 522156095 | 01 | MD | TRICARE | OTHER | 522156095 | 01 | MD | UNITED BEHAVIORAL HEALTH | OTHER | 522156095 | 01 | MD | VALUE OPTIONS | OTHER | 499188 | 01 | MD | VO-MHA | OTHER | 346646 | 01 | MD | MHN | OTHER | LM49EA | 01 | MD | CAREFIRST BCBS | OTHER | 522156095 | 01 | MD | AMERICAN PSYCH SYSTEM HEALTHCARE | OTHER | 609550002 | 05 | MD | MEDICAID |