Provider Demographics
NPI:1043244247
Name:UTEVSKY, JUDITH A (LCSW)
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:A
Last Name:UTEVSKY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2030 HELENA ST
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53704-5520
Mailing Address - Country:US
Mailing Address - Phone:608-630-7105
Mailing Address - Fax:
Practice Address - Street 1:700 RAY-O-VAC DR
Practice Address - Street 2:SUITE 220
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53711-2476
Practice Address - Country:US
Practice Address - Phone:608-276-9191
Practice Address - Fax:608-276-9144
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2016-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI40929200Medicaid
WI40929200Medicaid