Individual provider Active NPI

Kimberly L. Maddux, MSW, LCSW, LAC

  • Clinical Social Worker
  • Denver, CO
National Provider Identifier
1245201839
Registry record updated Aug 7, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
992213 Issued in CO
Practice address
4455 E 12TH Ave
Denver, CO 80220-2415
Phone
(303) 504-7710
Fax
(303) 504-7792
NPI assigned
Jan 31, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 7, 2019

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction (Substance Use Disorder) Counselor 101YA0400X 171 CO
Clinical Social Worker 1041C0700X 992213 CO Primary

Addresses

Primary practice location

4455 E 12TH Ave
Denver, CO 80220-2415

Mailing address

4141 E Dickenson PL
Denver, CO 80222-6012
Phone (303) 504-6509

Other names 1

  • Kimberly L. Kaufman Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040525001007 CO Practitioner - Clinical Social Worker 8921089152 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
171COMDClinical Social Worker
992213COMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Mental Health Center of Denver Current Accepting new patients
Mental Health Center of Denver CurrentSince Sep 17, 2019 Accepting new patients
Mental Health Center of Denver CurrentSince Sep 17, 2019 Accepting new patients

Locations

4141 E Dickenson Pl
Denver, CO 80222
Phone (303) 504-6509

4455 E 12th Ave
Denver, CO 80220
Phone (303) 504-7782

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1138665600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1565136000000",
    "number": "1245201839",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4141 E DICKENSON PL",
            "city": "DENVER",
            "state": "CO",
            "postal_code": "802226012",
            "telephone_number": "303-504-6509",
            "fax_number": "303-782-0916"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4455 E 12TH AVE",
            "city": "DENVER",
            "state": "CO",
            "postal_code": "802202415",
            "telephone_number": "303-504-7710",
            "fax_number": "303-504-7792"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MADDUX",
        "first_name": "KIMBERLY",
        "middle_name": "L.",
        "credential": "MSW, LCSW, LAC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-01-31",
        "last_updated": "2019-08-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "CO",
            "license": "171",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CO",
            "license": "992213",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KIMBERLY",
            "last_name": "KAUFMAN",
            "middle_name": "L.",
            "credential": "MSW, LCSW, LAC",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Denver, CO

Sources for this page

Verify at the official NPI Registry.