Mary Therese Jansen-Kubicek, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

2521-123 Issued in WI

Practice address

1751 N 73Rd St
Wauwatosa, WI 53213-2214

Phone

(414) 940-5691

NPI assigned

Aug 7, 2023

Last updated

Aug 7, 2023By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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)

Not enrolled

State licenses

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

{
    "created_epoch": "1691366400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1691366400000",
    "number": "1770265944",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1751 N 73RD ST",
            "city": "WAUWATOSA",
            "state": "WI",
            "postal_code": "532132214",
            "telephone_number": "414-940-5691"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1751 N 73RD ST",
            "city": "WAUWATOSA",
            "state": "WI",
            "postal_code": "532132214",
            "telephone_number": "414-940-5691"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JANSEN-KUBICEK",
        "first_name": "MARY",
        "middle_name": "THERESE",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2023-08-07",
        "last_updated": "2023-08-07",
        "certification_date": "2023-08-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "WI",
            "license": "2521-123",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Clinical Social Worker in Wauwatosa, WI
• Providers in Wauwatosa, 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 Aug 7, 2023; 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.