Provider Demographics
NPI:1477632552
Name:CITRON, BETH ANN (LCSW)
Entity Type:Individual
Prefix:
First Name:BETH
Middle Name:ANN
Last Name:CITRON
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:PO BOX 3943
Mailing Address - Street 2:
Mailing Address - City:HAILEY
Mailing Address - State:ID
Mailing Address - Zip Code:83333-3943
Mailing Address - Country:US
Mailing Address - Phone:208-450-9047
Mailing Address - Fax:
Practice Address - Street 1:400 S MAIN ST STE 302
Practice Address - Street 2:
Practice Address - City:HAILEY
Practice Address - State:ID
Practice Address - Zip Code:83333-8856
Practice Address - Country:US
Practice Address - Phone:208-450-9047
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-02
Last Update Date:2020-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID14031041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical