Provider Demographics
NPI:1235398017
Name:MRAZ, CHIVONNE MARIE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:CHIVONNE
Middle Name:MARIE
Last Name:MRAZ
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:CHIVONNE
Other - Middle Name:MARIE
Other - Last Name:SWEENEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:428 6TH AVE
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:ID
Mailing Address - Zip Code:83501-2355
Mailing Address - Country:US
Mailing Address - Phone:208-799-6500
Mailing Address - Fax:208-799-6504
Practice Address - Street 1:428 6TH AVE
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ID
Practice Address - Zip Code:83501-2355
Practice Address - Country:US
Practice Address - Phone:208-799-6500
Practice Address - Fax:208-799-6504
Is Sole Proprietor?:No
Enumeration Date:2008-06-05
Last Update Date:2015-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARC60019333104100000X
IDLCSW-347551041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker