MEDICARE: MS. KIMBERLY L. BEAN LCSW, CADC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	3671-123 AND 1377	WI
2	1041C0700X	Clinical Social Worker	3671-123	WI
3	101YA0400X	Addiction (Substance Use Disorder) Counselor	1377-132	WI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	391627035010	OTHER	WI	BLUE CROSS/BLUE SHIELD
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	12020	OTHER	WI	DEAN HEALTH PLAN
4	999003778	OTHER	WI	WPS

General Provider Information

NPI Number	:	1508822396
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KIMBERLY L. BEAN LCSW, CADC

Provider Business Mailing Address
First Line	:	7617 MINERAL POINT RD
Second Line	:	STE 300
City	:	MADISON
State	:	WI
Zip	:	53717-1623
Country	:	US
Telephone Number	:	608-833-9290
Fax Number	:	608-833-9691

Provider Business Practice Location Address
First Line	:	7617 MINERAL POINT RD
Second Line	:	STE 300
City	:	MADISON
State	:	WI
Zip	:	53717-1623
Country	:	US
Telephone Number	:	608-833-9290
Fax Number	:	608-833-9691

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/21/2006
Last Update Date	:	01/19/2011

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Directions to “ MS. KIMBERLY L. BEAN LCSW, CADC” Practice Location

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