Healthcare Provider Details

I. General information

NPI: 1992021380
Provider Name (Legal Business Name): SUSAN WALKER RUSKIN M.S.W
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/11/2010
Last Update Date: 04/11/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 CAMINO ALTO
MILL VALLEY CA
94941-2929
US

IV. Provider business mailing address

5106 SHELTER BAY AVE
MILL VALLEY CA
94941-6019
US

V. Phone/Fax

Practice location:
  • Phone: 415-381-8336
  • Fax:
Mailing address:
  • Phone: 415-381-8336
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCS10871
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFC4564
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: