Provider Demographics
NPI:1235814344
Name:NABARRETE-STUART, JERRY JR (LSMW)
Entity Type:Individual
Prefix:MR
First Name:JERRY
Middle Name:
Last Name:NABARRETE-STUART
Suffix:JR
Gender:M
Credentials:LSMW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6933 W EMERALD ST
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83704-8616
Mailing Address - Country:US
Mailing Address - Phone:208-321-0634
Mailing Address - Fax:
Practice Address - Street 1:6933 W EMERALD ST
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83704-8616
Practice Address - Country:US
Practice Address - Phone:208-321-0634
Practice Address - Fax:208-321-1082
Is Sole Proprietor?:No
Enumeration Date:2023-06-16
Last Update Date:2023-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLMSW-43688101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor