Ksenia Ustinova, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

138685 Issued in CA

Practice address

3079 Harrison Ave #12 #118
South Lake Tahoe, CA 96150

Phone

(530) 447-0253

NPI assigned

Aug 25, 2021

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Root & Return Therapy, a Licensed Clinical Social Worker Professional Corporation

  • Clinical Social Worker
  • South Lake Tahoe, CA
  • NPI 1821914995
  NPD (past) Authorized official
• Turning Point Community Programs - PSH

  • Adult Mental Health Clinic/Center
  • Sacramento, CA
  • NPI 1114054475
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1629849600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1782345600000",
    "number": "1114694338",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 9683",
            "city": "SOUTH LAKE TAHOE",
            "state": "CA",
            "postal_code": "961582683",
            "telephone_number": "916-248-9264"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3079 HARRISON AVE #12 #118",
            "city": "SOUTH LAKE TAHOE",
            "state": "CA",
            "postal_code": "96150",
            "telephone_number": "530-447-0253"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "7005 N Lake Blvd # 166",
            "address_purpose": "LOCATION",
            "city": "Tahoe Vista",
            "state": "CA",
            "postal_code": "961489800",
            "country_code": "US",
            "telephone_number": "530-447-0253",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "USTINOVA",
        "first_name": "KSENIA",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-08-25",
        "last_updated": "2026-06-25",
        "certification_date": "2026-06-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CA",
            "license": "138685",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Julia Marie Trizuto
• Roderick Randolph Turner, MD
• Marta Tuznik
• Tyler Peterson DO Inc
• Haley Juliet Uriz
• April France Vadnais
• Lucila Valencia-Salazar
• Leeann Rose Vanbeenen
• Deborah Ann Vance, MFCC
• Jeremy Scott Vandehurst, L-AT

• Clinical Social Worker in South Lake Tahoe, CA
• Providers in South Lake Tahoe, CA by specialty
• Clinical Social Worker in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 25, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.