Provider Demographics
NPI:1376213785
Name:FAUTH, SARAH MARIA (LMSW)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:MARIA
Last Name:FAUTH
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:418 DRIFTWOOD RD
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83713-7902
Mailing Address - Country:US
Mailing Address - Phone:208-369-8949
Mailing Address - Fax:208-908-7883
Practice Address - Street 1:11513 W FAIRVIEW AVE STE 105
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83713-7887
Practice Address - Country:US
Practice Address - Phone:208-908-7882
Practice Address - Fax:208-908-7883
Is Sole Proprietor?:No
Enumeration Date:2021-09-16
Last Update Date:2021-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID41140104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker