Provider Demographics
NPI:1457638801
Name:MUNTZ, JADE D (LMSW)
Entity Type:Individual
Prefix:MISS
First Name:JADE
Middle Name:D
Last Name:MUNTZ
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 1:201 N 21ST AVE
Mailing Address - Street 2:
Mailing Address - City:CALDWELL
Mailing Address - State:ID
Mailing Address - Zip Code:83605-4371
Mailing Address - Country:US
Mailing Address - Phone:208-455-1222
Mailing Address - Fax:
Practice Address - Street 1:201 N 21ST AVE
Practice Address - Street 2:
Practice Address - City:CALDWELL
Practice Address - State:ID
Practice Address - Zip Code:83605-4371
Practice Address - Country:US
Practice Address - Phone:208-455-1222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-14
Last Update Date:2011-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID31641104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker