Provider Demographics
NPI:1861503385
Name:BIONDOLILLO, LENA J (LCPC)
Entity Type:Individual
Prefix:
First Name:LENA
Middle Name:J
Last Name:BIONDOLILLO
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:LENA
Other - Middle Name:J
Other - Last Name:WRIGHT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:4444 W TAFT ST
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83703-4148
Mailing Address - Country:US
Mailing Address - Phone:208-501-2181
Mailing Address - Fax:
Practice Address - Street 1:4444 W TAFT ST
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83703-4148
Practice Address - Country:US
Practice Address - Phone:208-501-2181
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2015-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC-11120101YP2500X
IDLCPC5071101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional