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NPI Code Detail

MEDICARE: SUSAN RUTH DUCKSTEIN

MEDICARE: SUSAN RUTH DUCKSTEIN
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
11041C0700XClinical Social WorkerLCS12255CA

General Provider Information

NPI Number : 1255666848
Entity Type Code : Individual
Provider Name (Legal Business Name) : SUSAN RUTH DUCKSTEIN
Provider Business Mailing Address
First Line : 10690 SAN PABLO AVE
Second Line :
City : EL CERRITO
State : CA
Zip : 94530-2620
Country : US
Telephone Number : 510-528-9590
Fax Number :
Provider Business Practice Location Address
First Line : 10690 SAN PABLO AVE
Second Line :
City : EL CERRITO
State : CA
Zip : 94530-2620
Country : US
Telephone Number : 510-528-9590
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/15/2009
Last Update Date : 10/15/2009

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Directions to “ SUSAN RUTH DUCKSTEIN ” Practice Location

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