Provider Demographics
NPI:1083807630
Name:SUAREZ, ALEX (LCSW)
Entity Type:Individual
Prefix:
First Name:ALEX
Middle Name:
Last Name:SUAREZ
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:85 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:DRIGGS
Mailing Address - State:ID
Mailing Address - Zip Code:83422-9700
Mailing Address - Country:US
Mailing Address - Phone:208-354-3005
Mailing Address - Fax:
Practice Address - Street 1:85 S MAIN ST
Practice Address - Street 2:
Practice Address - City:DRIGGS
Practice Address - State:ID
Practice Address - Zip Code:83422-9700
Practice Address - Country:US
Practice Address - Phone:208-354-3005
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-27
Last Update Date:2016-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCSW-307161041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDLCSW-30716OtherSTATE LICENSE NUMBER