Kimberly Anne Puetzer, LCSW-R

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

071148 Issued in NY

Practice address

138 North Court Street Madison Co. Mental Health Dept
Veterans Memorial Building
Wampsville, NY 13163-0608

Phone

(315) 366-2327

Fax

(315) 366-2599

NPI assigned

Jun 27, 2006

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

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

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.

• Madison County

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Wampsville, NY
  • NPI 1689780546
  NPD (past)

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

{
    "created_epoch": "1151366400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1525996800000",
    "number": "1629005616",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "138 NORTH COURT STREET MADISON CO. MENTAL HEALTH DEPT",
            "address_2": "VETERANS MEMORIAL BUILDING",
            "city": "WAMPSVILLE",
            "state": "NY",
            "postal_code": "131630608",
            "telephone_number": "315-366-2327",
            "fax_number": "315-366-2599"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "138 NORTH COURT STREET MADISON CO. MENTAL HEALTH DEPT",
            "address_2": "VETERANS MEMORIAL BUILDING",
            "city": "WAMPSVILLE",
            "state": "NY",
            "postal_code": "131630608",
            "telephone_number": "315-366-2327",
            "fax_number": "315-366-2599"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PUETZER",
        "first_name": "KIMBERLY",
        "middle_name": "ANNE",
        "name_prefix": "Ms.",
        "credential": "LCSW-R",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-27",
        "last_updated": "2018-05-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NY",
            "license": "071148",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MVP",
            "identifier": "615530",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Anna Pavia, LMSW
• Beth Perry
• Tessa Peters
• Shelley Petersen
• Nyka Phelps, LMSW, LCSW
• Rachel Theresa Quilty-Koval
• Samantha Jane Ratnour, LMSW
• Gabrielle Rose Reaves, MSW INTERN
• Gary Roy Roberts, CASAC
• Jahnae Nicole Roberts

• Clinical Social Worker in Wampsville, NY
• Providers in Wampsville, NY by specialty
• Clinical Social Worker in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 11, 2018; 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.