Provider Demographics
NPI:1952655490
Name:DIZDAR-BARAC, AIDA (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:AIDA
Middle Name:
Last Name:DIZDAR-BARAC
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 1:2273 S. VISTA AVENUE, SUITE 190
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83705
Mailing Address - Country:US
Mailing Address - Phone:208-343-2737
Mailing Address - Fax:
Practice Address - Street 1:2273 S. VISTA AVENUE, SUITE 190
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83705
Practice Address - Country:US
Practice Address - Phone:208-343-2737
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-06
Last Update Date:2021-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLMSW-32351104100000X
PACW0218831041C0700X
IDLCVSW-352151041C0700X
IDLCSW-352151041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDLCSW-35215OtherDIVISION OF OCCUPATIONAL AND PROFESSIONAL LIC - IDAHO BOARD OF
PACW021883OtherCOMMONWEALTH OF PENNSYLVANIA BUREAU OF PROFESSIONAL AND OCCUPATIONAL AFFAIRS
IDLMSW-32351OtherLICENSE NUMBER (MASTER IN SOCIAL WORK) LMSW