Petrovnia Fernande McIntosh, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

8317-123 Issued in WI

Practice address

6502 Grand Teton PLZ
Suite 102
Madison, WI 53719-1047

Phone

(608) 827-7220

Fax

(608) 827-7223

NPI assigned

Mar 25, 2014

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)

Enrolled

State licenses

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

{
    "created_epoch": "1395705600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1395705600000",
    "number": "1366869612",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6502 GRAND TETON PLZ",
            "address_2": "SUITE 102",
            "city": "MADISON",
            "state": "WI",
            "postal_code": "537191047",
            "telephone_number": "608-827-7220",
            "fax_number": "608-827-7223"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6502 GRAND TETON PLZ",
            "address_2": "SUITE 102",
            "city": "MADISON",
            "state": "WI",
            "postal_code": "537191047",
            "telephone_number": "608-827-7220",
            "fax_number": "608-827-7223"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCINTOSH",
        "first_name": "PETROVNIA",
        "middle_name": "FERNANDE",
        "name_prefix": "Ms.",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-03-25",
        "last_updated": "2014-03-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "WI",
            "license": "8317-123",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Timothy R McHugh, MD
• Emma Louise McIlheran, PT, DPT
• Brian Francis McIlhone, R.PH,
• Christina L McIntosh
• Gwenevere Charles McIntosh, MD
• Kelly McIntyre, NBC-HWC
• Chloe McKay
• Cole McKay
• Grace Eileen McKay, MD, MPH
• David G McKee, PH.D.

• Clinical Social Worker in Madison, WI
• Providers in Madison, WI by specialty
• Clinical Social Worker in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 25, 2014; 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.