Provider Demographics
NPI:1992042824
Name:SHARPE, JAIMIE L (LCSW)
Entity Type:Individual
Prefix:
First Name:JAIMIE
Middle Name:L
Last Name:SHARPE
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 1:223 N 6TH ST STE 240
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83702-6092
Mailing Address - Country:US
Mailing Address - Phone:208-917-2084
Mailing Address - Fax:208-550-8959
Practice Address - Street 1:223 N 6TH ST STE 240
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83702-6092
Practice Address - Country:US
Practice Address - Phone:208-917-2084
Practice Address - Fax:208-550-8959
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-11
Last Update Date:2023-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCSW-357531041C0700X, 251S00000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID1992042824Medicaid