Provider Demographics
NPI:1043415276
Name:RUSSELL, MONIQUE CLAUDETTE (LCSW)
Entity type:Individual
Prefix:MS
First Name:MONIQUE
Middle Name:CLAUDETTE
Last Name:RUSSELL
Suffix:
Gender:
Credentials:LCSW
Other - Prefix:
Other - First Name:MONIQUE
Other - Middle Name:CLAUDETTE
Other - Last Name:RUSSELL-BARNES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:LADSTUHL REGIONAL MEDICAL CENTER UNIT 33100
Mailing Address - Street 2:
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09180
Mailing Address - Country:DE
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:LADSTUHL REGIONAL MEDICAL CENTER UNIT 33100
Practice Address - Street 2:
Practice Address - City:APO
Practice Address - State:AE
Practice Address - Zip Code:09180
Practice Address - Country:DE
Practice Address - Phone:210-505-6420
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-18
Last Update Date:2025-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY052482104100000X
TX616361041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker