Individual provider · Type 1 NPI
Ksenia Ustinova, LCSW
Clinical Social Worker · South Lake Tahoe, CA
Practice location
3079 Harrison Ave #12 #118
South Lake Tahoe, CA 96150
Mailing address
PO Box 9683
South Lake Tahoe, CA 96158-2683
Other practice locations
- 7005 N Lake Blvd # 166, Tahoe Vista, CA 96148-9800 · (530) 447-0253
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Clinical Social Worker Primary | 1041C0700X | 138685 (CA) |
Clinical Social Worker: A social worker who holds a master's or doctoral degree in social work from an accredited school of social work in addition to at least two years of post-master's supervised experience in a clinical setting. The social worker must be licensed, certified, or registered at the clinical level in the jurisdiction of practice. A clinical social worker provides direct services, including interventions focused on interpers…
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About NPI 1114694338
Ksenia Ustinova, LCSW's National Provider Identifier is 1114694338, issued on Aug 25, 2021. The primary taxonomy on file is Clinical Social Worker (1041C0700X), and the practice location is in South Lake Tahoe, CA. The record was last updated on Jun 25, 2026.