Provider Demographics
NPI:1174734404
Name:KUSKULIS, VALERIE (LCSW)
Entity type:Individual
Prefix:
First Name:VALERIE
Middle Name:
Last Name:KUSKULIS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:VALERIE
Other - Middle Name:
Other - Last Name:ROY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3900 LAKEVILLE HWY
Mailing Address - Street 2:
Mailing Address - City:PETALUMA
Mailing Address - State:CA
Mailing Address - Zip Code:94954-5698
Mailing Address - Country:US
Mailing Address - Phone:707-765-3573
Mailing Address - Fax:707-765-3816
Practice Address - Street 1:3900 LAKEVILLE HWY
Practice Address - Street 2:
Practice Address - City:PETALUMA
Practice Address - State:CA
Practice Address - Zip Code:94954-5698
Practice Address - Country:US
Practice Address - Phone:707-765-3573
Practice Address - Fax:707-765-3816
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS111491041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical