Provider Demographics
NPI:1619545530
Name:KAESTNER, CORAREINE FLORA (LMSW)
Entity Type:Individual
Prefix:
First Name:CORAREINE
Middle Name:FLORA
Last Name:KAESTNER
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 1:10448 W GARVERDALE CT STE 606
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83704-5474
Mailing Address - Country:US
Mailing Address - Phone:208-286-1529
Mailing Address - Fax:
Practice Address - Street 1:10448 W GARVERDALE CT STE 606
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83704-5474
Practice Address - Country:US
Practice Address - Phone:208-286-1529
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-16
Last Update Date:2021-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID408681041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID40868OtherLMSW IDAHO