Provider Demographics
NPI:1649416454
Name:JUAREZ, ALICIA (LMSW)
Entity Type:Individual
Prefix:
First Name:ALICIA
Middle Name:
Last Name:JUAREZ
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 1:207 W GEORGIA AVE STE 150
Mailing Address - Street 2:
Mailing Address - City:NAMPA
Mailing Address - State:ID
Mailing Address - Zip Code:83686-3024
Mailing Address - Country:US
Mailing Address - Phone:208-489-5700
Mailing Address - Fax:209-489-4077
Practice Address - Street 1:207 W GEORGIA AVE STE 150
Practice Address - Street 2:
Practice Address - City:NAMPA
Practice Address - State:ID
Practice Address - Zip Code:83686-3024
Practice Address - Country:US
Practice Address - Phone:208-489-5700
Practice Address - Fax:209-489-4077
Is Sole Proprietor?:No
Enumeration Date:2008-12-29
Last Update Date:2008-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLMSW25058104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker