Provider Demographics
NPI:1205561248
Name:WILFONG, CATHARINE A (LCSW)
Entity type:Individual
Prefix:
First Name:CATHARINE
Middle Name:A
Last Name:WILFONG
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:CATHARINE
Other - Middle Name:
Other - Last Name:ANDERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:6533 W EMERALD ST
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83704-8737
Mailing Address - Country:US
Mailing Address - Phone:208-302-5232
Mailing Address - Fax:
Practice Address - Street 1:6533 W EMERALD ST
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83704-8737
Practice Address - Country:US
Practice Address - Phone:208-302-5200
Practice Address - Fax:208-302-5225
Is Sole Proprietor?:No
Enumeration Date:2022-07-22
Last Update Date:2022-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCSW-393581041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical