Provider Demographics
NPI:1760827307
Name:BISARO, BARBARA JEAN (LSW)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:JEAN
Last Name:BISARO
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2120 N LAKEWOOD DR STE B
Mailing Address - Street 2:
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83814-2638
Mailing Address - Country:US
Mailing Address - Phone:208-667-3179
Mailing Address - Fax:208-667-5938
Practice Address - Street 1:2120 N LAKEWOOD DR STE B
Practice Address - Street 2:
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814-2638
Practice Address - Country:US
Practice Address - Phone:208-667-3179
Practice Address - Fax:208-667-5938
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-09
Last Update Date:2013-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLSW-25831104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker