Amy Kucin, MS
Individual provider Active NPI Clinical Social Worker · Madison, WI
NPI 1750599031 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1750599031
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Social Worker 1041C0700X
- License
- 126847 (WI)
- Practice address
- 625 W Washington Ave
Madison, WI 53703-2637 - Phone
- (608) 280-2700
- NPI assigned
- May 18, 2007
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 2
Medicare Care Compare profile
- Specialty
- Clinical Social Worker
- Education
- Other, 2005
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Family Therapy Center of Madison, Inc.
Practice addresses (Care Compare)
700 Ray O Vac Dr
Suite 220
Madison, WI 53711-2476
Phone (608) 276-9191
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in WI
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20231222002341 | WI | Practitioner - Clinical Social Worker | 3971730805 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 126847 | WI | MD | Clinical Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Family Therapy Center of Madison, Inc. | Clinical | Current |
Accepting new patients |
| Peter C. Jackson, PSYD Consulting, SC | Current |
Accepting new patients |
Locations
700 Ray O Vac Dr
Ste 220
Madison, WI 53711
Phone (608) 276-9191
10 E Doty St
Ste 445
Madison, WI 53703
Phone (608) 276-9191
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 126847 | WI | Yes |
Addresses
Primary practice location
625 W Washington Ave
Madison, WI 53703-2637
Mailing address
625 W Washington Ave
Madison, WI 53703-2637
Other providers in Madison, WI
- Ted Kubiak
- Phillip Adam Kubica
- Morgan Jean Kubicek
- Angel Joy Kubly
- Kevin L Kubly
- Aleksandra Kuczmarska-Haas
- Nathan Kudick
- Kenneth A Kudsk
- Manila Kue
- McKenzie Kuebli
All providers in Madison, WI · Clinical Social Worker in Wisconsin
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.