Provider Demographics
NPI:1063567139
Name:RUSSELL, MERCY BURTON (LCSW)
Entity type:Individual
Prefix:DR
First Name:MERCY
Middle Name:BURTON
Last Name:RUSSELL
Suffix:
Gender:
Credentials:LCSW
Other - Prefix:MRS
Other - First Name:MERCY
Other - Middle Name:RUSSELL
Other - Last Name:HYDE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:14 BACON STREET
Mailing Address - Street 2:SUITE 204
Mailing Address - City:BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05401
Mailing Address - Country:US
Mailing Address - Phone:802-233-1142
Mailing Address - Fax:802-497-1150
Practice Address - Street 1:14 BACON STREET
Practice Address - Street 2:SUITE 204
Practice Address - City:BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05401
Practice Address - Country:US
Practice Address - Phone:802-233-1142
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-25
Last Update Date:2025-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ195501041C0700X
NMSWB-2025-00221041C0700X
VT89-00002121041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT89-0000212OtherVERMONT LCSW
VT821-8223OtherVERMONT BCBS PIN