Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Ksenia Ustinova, LCSW

Individual provider Clinical Social Worker · NPI 1114694338

Ksenia Ustinova, LCSW is a Clinical Social Worker in South Lake Tahoe, California. Works from 2 locations. Licensed in California.

Licensed in
CA
In the registry since
2021
What do these letters mean?
LCSW — Licensed Clinical Social Worker
A social worker licensed to diagnose and treat mental health conditions independently.

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Practice location Address checks out

3079 Harrison Ave #12 #118
South Lake Tahoe, CA 96150
Phone: (530) 447-0253
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 7005 N Lake Blvd # 166, Tahoe Vista, CA 96148-9800 — (530) 447-0253

Specialties & licences

Clinical Social Worker (primary) Taxonomy 1041C0700X · Licence 138685 (CA)

Record details

NPI number1114694338
Entity typeIndividual (Type 1)
GenderFemale
Credentials LCSW
Sole proprietorNo
NPI enumeratedAugust 25, 2021
Last updated in NPPESJune 25, 2026
Certification dateJune 25, 2026

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