Provider Demographics
NPI:1629005616
Name:PUETZER, KIMBERLY ANNE (LCSW-R)
Entity type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:ANNE
Last Name:PUETZER
Suffix:
Gender:F
Credentials:LCSW-R
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Other - Credentials:
Mailing Address - Street 1:138 NORTH COURT STREET MADISON CO. MENTAL HEALTH DEPT
Mailing Address - Street 2:VETERANS MEMORIAL BUILDING
Mailing Address - City:WAMPSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13163-0608
Mailing Address - Country:US
Mailing Address - Phone:315-366-2327
Mailing Address - Fax:315-366-2599
Practice Address - Street 1:138 NORTH COURT STREET MADISON CO. MENTAL HEALTH DEPT
Practice Address - Street 2:VETERANS MEMORIAL BUILDING
Practice Address - City:WAMPSVILLE
Practice Address - State:NY
Practice Address - Zip Code:13163-0608
Practice Address - Country:US
Practice Address - Phone:315-366-2327
Practice Address - Fax:315-366-2599
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2018-05-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY0711481041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY615530OtherMVP
NYRA0245Medicare ID - Type Unspecified