Provider Demographics
NPI:1427185347
Name:LUSKIN, FREDERIC
Entity Type:Individual
Prefix:
First Name:FREDERIC
Middle Name:
Last Name:LUSKIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1101 WELCH RD
Mailing Address - Street 2:SUITE A6
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94304-1904
Mailing Address - Country:US
Mailing Address - Phone:650-498-5566
Mailing Address - Fax:650-498-5640
Practice Address - Street 1:1101 WELCH RD
Practice Address - Street 2:SUITE A6
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94304-1904
Practice Address - Country:US
Practice Address - Phone:650-498-5566
Practice Address - Fax:650-498-5640
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA29624106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist