Provider Demographics
NPI:1023889607
Name:CANTER, JAYCEE DANIELLE (LMSW)
Entity type:Individual
Prefix:
First Name:JAYCEE
Middle Name:DANIELLE
Last Name:CANTER
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:JAYCEE
Other - Middle Name:
Other - Last Name:DAVIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3501 W ELDER ST STE 300
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83705-4986
Mailing Address - Country:US
Mailing Address - Phone:208-286-1529
Mailing Address - Fax:208-445-2285
Practice Address - Street 1:3501 W ELDER ST STE 300
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83705-4986
Practice Address - Country:US
Practice Address - Phone:208-286-1529
Practice Address - Fax:208-445-2285
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-11
Last Update Date:2024-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLMSW-44544104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker