Provider Demographics
NPI:1992021380
Name:RUSKIN, SUSAN WALKER (MSW)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:WALKER
Last Name:RUSKIN
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5106 SHELTER BAY AVE
Mailing Address - Street 2:
Mailing Address - City:MILL VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94941-6019
Mailing Address - Country:US
Mailing Address - Phone:415-381-8336
Mailing Address - Fax:
Practice Address - Street 1:45 CAMINO ALTO
Practice Address - Street 2:
Practice Address - City:MILL VALLEY
Practice Address - State:CA
Practice Address - Zip Code:94941-2929
Practice Address - Country:US
Practice Address - Phone:415-381-8336
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-11
Last Update Date:2010-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS108711041C0700X
CAMFC4564106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist