MEDICARE: KSENIA USTINOVA ACSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	104100000X	Social Worker	118870	CA

General Provider Information

NPI Number	:	1114694338
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KSENIA USTINOVA ACSW

Provider Business Mailing Address
First Line	:	PO BOX 9683
Second Line	:
City	:	SOUTH LAKE TAHOE
State	:	CA
Zip	:	96158-2683
Country	:	US
Telephone Number	:	916-248-9264
Fax Number	:

Provider Business Practice Location Address
First Line	:	2100 ELOISE AVE
Second Line	:
City	:	SOUTH LAKE TAHOE
State	:	CA
Zip	:	96150-4306
Country	:	US
Telephone Number	:	530-544-1748
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/25/2021
Last Update Date	:	08/07/2024

Similar Medicare Providers

1013297837 — A BALANCED LIFE: INDIVIDUAL, FAMILY & CHILD THERAPY, INC.
Practice Location Address:

2100 ELOISE AVE
SOUTH LAKE TAHOE, CA
96150-4306

Practice Phone: 530-544-1748
Practice Fax: 530-544-1728

1083153837 — A BALANCED LIFE: INDIVIDUAL, FAMILY AND CHILD THERAPY, INC
Practice Location Address:

2100 ELOISE AVE
SOUTH LAKE TAHOE, CA
96150-4306

Practice Phone: 530-544-1748
Practice Fax: 530-544-1728

1053276816 — MS. KAYE MARY BRINDLEY LCSW
Practice Location Address:

2100 ELOISE AVE
SOUTH LAKE TAHOE, CA
96150-4306

Practice Phone: 530-328-0018
Practice Fax:

1457573271 — MARY ANN CHONG LIM MD
Practice Location Address:

3400 CIVIC CENTER BLVD , 1 SOUTH PAVILION
PHILADELPHIA, PA
19104-4306

Practice Phone: 215-662-2638
Practice Fax: 215-349-5703

1992900641 — ESTEBAN ISAAC GOMEZ MD
Practice Location Address:

701 SOUTH PARKER STREET , SUITE 1000
ORANGE, CA
92868-4306

Practice Phone: 714-221-1200
Practice Fax: 714-221-1299

1952597858 — VANESSA KARINA SALINAS-LUNA MD
Practice Location Address:

701 SOUTH PARKER STREET , SUITE 1000
ORANGE, CA
92868-4306

Practice Phone: 714-221-1200
Practice Fax: 714-221-1299

Directions to “ KSENIA USTINOVA ACSW” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.