ANGELA RUSSELL — NPI 1376665992 (Licensed & Credentialed Behavioral Health & Social Service Providers

CMS-1500 Box 24J / 33a • NPI

1376665992

Type 2 Organization (Box 32a/33a)

HIPAA NUCC Taxonomy • CMS Code

103TC1900X (CMS 62)

Licensed & Credentialed Behavioral Health & Social Service Providers — Psychologist, Counseling

Box 32 Service Location & ZIP+4

1300 MERCANTILE LN, SUITE 139-J, LARGO, MD, 20774-5327

✓ 9-Digit EDI 837 ZIP+4 (20774-5327)

Practice Phone & Referral Fax

(301) 574-5976

Fax: (301) 574-5986

✓ HHS OIG LEIE Sanction Screening — VERIFIED CLEAR: NPI 1376665992 (ANGELA RUSSELL) has 0 active federal exclusions across all 84,224 HHS OIG LEIE sanction records (Database Verified: 2026-11-11).

CMS Medicare Order & Referring PECOS Eligibility

Institutional Type-2 NPI facilities enroll via CMS-855A institutional provider agreements rather than individual Order & Referring PECOS.

Official CMS NPPES Credential & Practice Profile

10-Digit NPI Number	`1376665992` (NPI-2 Organization / Facility)
Provider / Legal Name	ANGELA RUSSELL
Plain-English Specialty	Licensed & Credentialed Behavioral Health & Social Service Providers — Psychologist, Counseling NUCC Code: `103TC1900X` (Psychologist, Counseling)
Certifying / Licensing Body	State Medical / Healthcare Licensing Board & National Specialty Board
Practice Location Address	1300 MERCANTILE LN, SUITE 139-J, LARGO, MD, 20774-5327
Practice Telephone / Fax	Tel: (301) 574-5976 \| Fax: (301) 574-5986
Administrative Mailing Address	16306 BROOKTRAIL CT, UPPER MARLBORO, MD, 20772-3272
Enumeration & Last Sync	Enumerated: 2007-04-04 \| CMS Record Updated: 2008-06-25
Authorized Official	ANGELA RUSSELL (President)

Clinic Location, Accessibility & Directions

📍 Practice Location & Patient Access

1300 MERCANTILE LN, SUITE 139-J, LARGO, MD, 20774-5327

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Plain-English Taxonomy & CMS Crosswalk (103TC1900X)

What Does Taxonomy Code 103TC1900X Mean?

In the HIPAA National Uniform Claim Committee (NUCC) classification, code 103TC1900X translates to:
"Licensed & Credentialed Behavioral Health & Social Service Providers — Psychologist, Counseling"

CMS-1500 Medicare Specialty Crosswalk: CMS Code 62 (Psychologist, Clinical)
Certifying / Accrediting Authority: State Medical / Healthcare Licensing Board & National Specialty Board
Clinical Scope: Consult a verified Psychologist, Counseling for specialized diagnostic evaluation, treatment planning, and continuity of care.

Specialty Clinical Procedures & Therapeutic Classes

Standard Scope of Care (ANGELA RUSSELL)

Typical CPT / Diagnostic Procedures:

Comprehensive Outpatient & Inpatient Clinical Evaluation (CPT 99202–99215)
Diagnostic Workup, Laboratory Ordering & Evidence-Based Care Coordination
Preventive Screening, Patient Counseling & Multidisciplinary Referral

Common Therapeutic Classes:

Evidence-Based Specialty Pharmacotherapy & Preventive Regimens (CMS Part D Standard)

All Registered NUCC Taxonomies & State Licenses

Taxonomy Code & Plain-English Description	State License & Primary Status
`103TC1900X` — Psychologist, Counseling Plain English: Licensed & Credentialed Behavioral Health & Social Service Providers — Psychologist, Counseling	State: MD \| License: `LC1591` \| Primary: Yes (Primary)

Medical Billing, RCM & Hospital Credentialing Teams:

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ANGELA RUSSELL (NPI #1376665992)