Provider Demographics
NPI:1013533231
Name:OH, SYLVIA (LCSW)
Entity Type:Individual
Prefix:
First Name:SYLVIA
Middle Name:
Last Name:OH
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 1:2118 S LATAH ST
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83705-3947
Mailing Address - Country:US
Mailing Address - Phone:208-999-7424
Mailing Address - Fax:
Practice Address - Street 1:2118 S LATAH ST
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83705-3947
Practice Address - Country:US
Practice Address - Phone:208-999-7424
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-23
Last Update Date:2023-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA159151041C0700X
IDLCSW381611041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical