Provider Demographics
NPI:1356627954
Name:PRINCE, ANNIE GOITEIN (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:ANNIE
Middle Name:GOITEIN
Last Name:PRINCE
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 1:5999 W STATE ST
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83703-5059
Mailing Address - Country:US
Mailing Address - Phone:208-412-4192
Mailing Address - Fax:
Practice Address - Street 1:5999 W STATE ST
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83703-5059
Practice Address - Country:US
Practice Address - Phone:208-853-5095
Practice Address - Fax:208-853-5125
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-26
Last Update Date:2014-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCSW-337241041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical