Provider Demographics
NPI:1689609190
Name:UBERUAGA, DAMIANA L (LCSW)
Entity Type:Individual
Prefix:
First Name:DAMIANA
Middle Name:L
Last Name:UBERUAGA
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 1:131 N ALLUMBAUGH ST
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83704-9204
Mailing Address - Country:US
Mailing Address - Phone:208-367-2175
Mailing Address - Fax:208-376-0285
Practice Address - Street 1:131 N ALLUMBAUGH ST
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83704-9204
Practice Address - Country:US
Practice Address - Phone:208-367-2175
Practice Address - Fax:208-376-0285
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2013-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCSW244451041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID1693019Medicare ID - Type UnspecifiedLCSW