Provider Demographics
NPI:1245317627
Name:RUSKIN, ANNETTE HEYWOOD (MSW, LCSW)
Entity type:Individual
Prefix:MS
First Name:ANNETTE
Middle Name:HEYWOOD
Last Name:RUSKIN
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:MS
Other - First Name:ANNETTE
Other - Middle Name:
Other - Last Name:HEYWOOD RUSKIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSW, LCSW
Mailing Address - Street 1:300 W CLARENDON AVE
Mailing Address - Street 2:SUITE 140
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85013-3420
Mailing Address - Country:US
Mailing Address - Phone:602-242-7383
Mailing Address - Fax:602-242-7387
Practice Address - Street 1:300 W CLARENDON AVE
Practice Address - Street 2:SUITE 140
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85013-3420
Practice Address - Country:US
Practice Address - Phone:602-242-7383
Practice Address - Fax:602-242-7387
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2014-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLCSW-101571041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical