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NPI Code Detail

MEDICARE: KIMBERLY L. MADDUX MSW, LCSW, LAC

MEDICARE: KIMBERLY L. MADDUX MSW, LCSW, LAC
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
1101YA0400XAddiction (Substance Use Disorder) Counselor171CO
21041C0700XClinical Social Worker992213CO

General Provider Information

NPI Number : 1245201839
Entity Type Code : Individual
Provider Name (Legal Business Name) : KIMBERLY L. MADDUX MSW, LCSW, LAC
Provider Business Mailing Address
First Line : 4141 E DICKENSON PL
Second Line :
City : DENVER
State : CO
Zip : 80222-6012
Country : US
Telephone Number : 303-504-6509
Fax Number : 303-782-0916
Provider Business Practice Location Address
First Line : 4455 E 12TH AVE
Second Line :
City : DENVER
State : CO
Zip : 80220-2415
Country : US
Telephone Number : 303-504-7710
Fax Number : 303-504-7792
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/31/2006
Last Update Date : 08/07/2019

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