Provider Demographics
NPI:1013912112
Name:RUSK, GREGORY SHELDON (LISW)
Entity Type:Individual
Prefix:MR
First Name:GREGORY
Middle Name:SHELDON
Last Name:RUSK
Suffix:
Gender:M
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1117 FEHL LN
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45230-4349
Mailing Address - Country:US
Mailing Address - Phone:513-260-8825
Mailing Address - Fax:513-832-2993
Practice Address - Street 1:1117 FEHL LN
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45230-4349
Practice Address - Country:US
Practice Address - Phone:513-260-8825
Practice Address - Fax:513-832-2993
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-15
Last Update Date:2023-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI 5801041C0700X
OHF 092106H00000X
OHI.0000580-SUPV1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0316251Medicaid
OH270347000OtherMAGELLAN
OHRUSW 17983Medicare ID - Type UnspecifiedCINCINNATI