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General NPI Number Information
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NPI Number | 1013912112
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Entity Type | Individual
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Provider Name | GREGORY SHELDON RUSK LISW
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Gender | Male
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Dates
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Enumeration Date | 06/15/2005
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Last Update Date | 05/01/2025
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Provider Practice Location Address
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Address Line | 1060 NIMITZVIEW DR STE 215
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City | CINCINNATI
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State | OH
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Zip | 45230-4351
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Country | US
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Telephone | 513-260-8825
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Fax | 513-832-2993
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Provider Business Mailing Address
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Address Line | 1060 NIMITZVIEW DR STE 215
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City | CINCINNATI
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State | OH
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Zip | 45230-4351
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Country | US
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Telephone | 513-260-8825
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Fax | 513-832-2993
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | F.0000092
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | I.0000580-SUPV
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License Number State | OH
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