Provider Demographics
NPI:1558339713
Name:THIMM-JURADO, LUCINDA C (MSSW LCSW)
Entity Type:Individual
Prefix:
First Name:LUCINDA
Middle Name:C
Last Name:THIMM-JURADO
Suffix:
Gender:F
Credentials:MSSW LCSW
Other - Prefix:
Other - First Name:LUCINDA
Other - Middle Name:C
Other - Last Name:THIMM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:402 GAMMON PL
Mailing Address - Street 2:SUITE 290
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53719-1045
Mailing Address - Country:US
Mailing Address - Phone:608-833-9770
Mailing Address - Fax:608-833-1197
Practice Address - Street 1:402 GAMMON PL
Practice Address - Street 2:SUITE 290
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53719-1045
Practice Address - Country:US
Practice Address - Phone:608-833-9770
Practice Address - Fax:608-833-1197
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2017-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WILCSW2414123101YM0800X, 106H00000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39646600Medicaid
007015490Medicare ID - Type Unspecified
WI39646600Medicaid