Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Mrs. Mary Beth Russo Blackwell, LCSW

Individual provider Clinical Social Worker · NPI 1063731263

Mrs. Mary Beth Russo Blackwell, LCSW is a Clinical Social Worker in Ormond Beach, Florida. Qualified in 2008, 18 years ago. Accepts Medicare assignment and offers telehealth. Licensed in Florida.

Years since qualifying
18
Licensed in
FL
In the registry since
2010
What do these letters mean?
LCSW — Licensed Clinical Social Worker
A social worker licensed to diagnose and treat mental health conditions independently.

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Practice location Address checks out

220 Arlington Way
Ormond Beach, FL 32176-8164
Phone: (386) 882-7251
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Clinical Social Worker (primary) Taxonomy 1041C0700X · Licence SW18791 (FL)

Record details

NPI number1063731263
Entity typeIndividual (Type 1)
GenderFemale
Credentials LCSW
Sole proprietorNo
NPI enumeratedMay 27, 2010
Last updated in NPPESMarch 3, 2025
Certification dateMarch 3, 2025

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyCLINICAL SOCIAL WORKER
Medical schoolOTHER
Graduated 2008 (18 years in practice)
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
TelehealthOffers telehealth services

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