Provider Demographics
NPI:1225254592
Name:RUSCIO, THERESA MARIAN (LCSW)
Entity Type:Individual
Prefix:
First Name:THERESA
Middle Name:MARIAN
Last Name:RUSCIO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11217 GRAY ST
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CO
Mailing Address - Zip Code:80020-6874
Mailing Address - Country:US
Mailing Address - Phone:303-464-8105
Mailing Address - Fax:303-420-6517
Practice Address - Street 1:9035 WADSWORTH PKWY
Practice Address - Street 2:2750
Practice Address - City:WESTMINSTER
Practice Address - State:CO
Practice Address - Zip Code:80021-8634
Practice Address - Country:US
Practice Address - Phone:303-464-8105
Practice Address - Fax:303-420-6517
Is Sole Proprietor?:No
Enumeration Date:2007-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO9920721041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical