Provider Demographics
NPI:1134510738
Name:ROONEY, JUDITH (LCSW)
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:
Last Name:ROONEY
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:PO BOX 341
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:ID
Mailing Address - Zip Code:83501-0341
Mailing Address - Country:US
Mailing Address - Phone:208-743-8416
Mailing Address - Fax:208-743-4642
Practice Address - Street 1:1522 17TH ST
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ID
Practice Address - Zip Code:83501-3652
Practice Address - Country:US
Practice Address - Phone:208-743-8416
Practice Address - Fax:208-743-4642
Is Sole Proprietor?:No
Enumeration Date:2015-02-18
Last Update Date:2021-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW00005855104100000X
IDLCSW-350261041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker