Jeff R Kisicki, LCSW

Primary specialty

SpecialistTaxonomy code 174400000X

License

LCSW # 992298 Issued in CO

Practice address

2480 W 26TH Ave Ste 130B
Denver, CO 80211-5327

Phone

(303) 433-0188

NPI assigned

Feb 12, 2009

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• Collaborative Service for Change PC

  • Community/Behavioral Health Agency
  • Denver, CO
  • NPI 1902350788
  NPD (past) Authorized official

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

{
    "created_epoch": "1234396800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1234396800000",
    "number": "1447499595",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2480 W 26TH AVE STE 130B",
            "city": "DENVER",
            "state": "CO",
            "postal_code": "802115327",
            "telephone_number": "303-433-0188"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2480 W 26TH AVE STE 130B",
            "city": "DENVER",
            "state": "CO",
            "postal_code": "802115327",
            "telephone_number": "303-433-0188"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KISICKI",
        "first_name": "JEFF",
        "middle_name": "R",
        "name_prefix": "Mr.",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-02-12",
        "last_updated": "2009-02-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "CO",
            "license": "LCSW # 992298",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CORPORATE TAX ID #",
            "identifier": "20-1516883",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Sarah Marie Kirsch, FNP-C
• Lyle Edward Kirson, D.D.S.
• Alyssa Kirstein, LPCC
• Terri Jane Kirwan, M.A., L.P.C.
• Yuko Kishimoto, PH.D.
• Alexander Otis Kisor
• Sarah Kiss, MA, LPCC
• Theresa Kiss
• Connor Kissler
• Laura Kitchen

• Specialist in Denver, CO
• Providers in Denver, CO by specialty
• Specialist in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 12, 2009; 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.