Individual provider Active NPI

Judith A Utevsky, LCSW

  • Counselor
  • Madison, WI
National Provider Identifier
1043244247
Registry record updated Jul 19, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
CounselorTaxonomy code 101Y00000X
Practice address
700 Ray-O-Vac Dr
Suite 220
Madison, WI 53711-2476
Phone
(608) 276-9191
Fax
(608) 276-9144
NPI assigned
Jul 11, 2006
Last updated
Jul 19, 2016By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 19, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Counselor 101Y00000X NU Primary

Addresses

Primary practice location

700 Ray-O-Vac Dr
Suite 220
Madison, WI 53711-2476

Mailing address

2030 Helena St
Madison, WI 53704-5520
Phone (608) 630-7105

Other identifiers 1

IdentifierTypeStateIssuer
40929200MedicaidWI

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file
Eligible to order & refer
  • Part B services: No
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
2892WIMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Family Therapy Center of Madison, Inc. CurrentSince Jun 20, 2016 Accepting new patients
Peter C. Jackson, PSYD Consulting, SC CurrentSince Jun 20, 2016 Accepting new patients

Locations

700 Ray O Vac Dr
Ste 220
Madison, WI 53711
Phone (608) 276-9191

Organizations & group practices 2

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

NPI Registry JSON

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

{
    "created_epoch": "1152576000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1468886400000",
    "number": "1043244247",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2030 HELENA ST",
            "city": "MADISON",
            "state": "WI",
            "postal_code": "537045520",
            "telephone_number": "608-630-7105"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "700 RAY-O-VAC DR",
            "address_2": "SUITE 220",
            "city": "MADISON",
            "state": "WI",
            "postal_code": "537112476",
            "telephone_number": "608-276-9191",
            "fax_number": "608-276-9144"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "UTEVSKY",
        "first_name": "JUDITH",
        "middle_name": "A",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-07-11",
        "last_updated": "2016-07-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "40929200",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Madison, WI

Sources for this page

Verify at the official NPI Registry.