Recently Updated NPI Information — some details in this NPI profile have been updated in the NPI registry within the last 60 days.

KSENIA USTINOVA LCSW
NPI 1114694338
Social Worker - Clinical in South Lake Tahoe, CA

Active since August 25, 2021
3079 HARRISON AVE #12 #118, SOUTH LAKE TAHOE, CA 96150(530) 447-0253 Get Directions Write a Review

NPPES record last updated: June 25, 2026. Verified against the NPPES registry weekly; last sync: August 09, 2026.

Record update history: May 21, 2026, Aug 7, 2024, Aug 25, 2021 (3 updates tracked since 2021).

About Ksenia Ustinova Lcsw NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

KSENIA USTINOVA LCSW (NPI 1114694338) is an individual clinical provider in South Lake Tahoe, California, licensed in California (138685) and active in the NPI registry since August 2021. She maintains a secondary practice location in Tahoe Vista.

NPPES Registry Identity

NPI1114694338
Entity TypeIndividualFemale
Primary Taxonomy1041C0700X
Provider Legal NameKSENIA USTINOVACredential: LCSW
Location Address3079 HARRISON AVE #12 #118South Lake Tahoe, CA 96150
Mailing AddressPo Box 9683South Lake Tahoe, CA 96158-2683 · (916) 248-9264
Sole ProprietorNo
Enumeration DateAugust 25, 2021
Last NPPES UpdateJune 25, 20263 updates tracked since enumeration
NPPES CertifiedJune 25, 2026
NPI 1114694338 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

Primary SpecialtySocial Worker · ClinicalBehavioral Health & Social Service Providers
Taxonomy Code1041C0700X
License Licensed in CA · 138685
Definition
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 interpersonal interactions, intrapsychic dynamics, and life management issues. Clinical social work services are based on bio-psychosocial perspectives. Services consist of assessment, diagnosis, treatment (including psychotherapy and counseling), client-centered advocacy, consultation, evaluation, and prevention of mental illness, emotional, or behavioral disturbances.

Secondary Practice Location 1

Location 17005 N Lake Blvd # 166Tahoe Vista, CA 96148-9800 · Phone (530) 447-0253

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Ksenia Ustinova's NPI number?

The NPI number for Ksenia Ustinova is 1114694338. It was assigned to this individual provider in the NPPES registry on August 25, 2021.

Where is Ksenia Ustinova located?

Ksenia Ustinova practices at 3079 Harrison Ave #12 #118, South Lake Tahoe, CA 96150. The listed phone number is (530) 447-0253.

What is Ksenia Ustinova's specialty?

The primary specialty registered for this NPI is Social Worker, specializing in Clinical, with taxonomy code 1041C0700X.

When was this NPI record last updated?

The NPPES record for Ksenia Ustinova was last updated on June 25, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 46 days ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.