Provider Demographics
NPI:1255666848
Name:DUCKSTEIN, SUSAN RUTH
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:RUTH
Last Name:DUCKSTEIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:RUTH
Other - Last Name:DUCKSTEIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:10690 SAN PABLO AVE
Mailing Address - Street 2:
Mailing Address - City:EL CERRITO
Mailing Address - State:CA
Mailing Address - Zip Code:94530-2620
Mailing Address - Country:US
Mailing Address - Phone:510-528-9590
Mailing Address - Fax:
Practice Address - Street 1:10690 SAN PABLO AVE
Practice Address - Street 2:
Practice Address - City:EL CERRITO
Practice Address - State:CA
Practice Address - Zip Code:94530-2620
Practice Address - Country:US
Practice Address - Phone:510-528-9590
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-15
Last Update Date:2009-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS122551041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical