Healthcare Provider Details

I. General information

NPI: 1013912112
Provider Name (Legal Business Name): GREGORY SHELDON RUSK LISW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/15/2005
Last Update Date: 05/01/2025
Certification Date: 05/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1060 NIMITZVIEW DR STE 215
CINCINNATI OH
45230-4351
US

IV. Provider business mailing address

1060 NIMITZVIEW DR STE 215
CINCINNATI OH
45230-4351
US

V. Phone/Fax

Practice location:
  • Phone: 513-260-8825
  • Fax: 513-832-2993
Mailing address:
  • Phone: 513-260-8825
  • Fax: 513-832-2993

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI.0000580-SUPV
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberF.0000092
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: