Healthcare Provider Details

I. General information

NPI: 1558339713
Provider Name (Legal Business Name): LUCINDA C THIMM-JURADO MSSW LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LUCINDA C THIMM

II. Dates (important events)

Enumeration Date: 03/14/2006
Last Update Date: 08/10/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

402 GAMMON PL SUITE 290
MADISON WI
53719-1045
US

IV. Provider business mailing address

402 GAMMON PL SUITE 290
MADISON WI
53719-1045
US

V. Phone/Fax

Practice location:
  • Phone: 608-833-9770
  • Fax: 608-833-1197
Mailing address:
  • Phone: 608-833-9770
  • Fax: 608-833-1197

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLCSW2414123
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLCSW2414123
License Number StateWI
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW2414123
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: