Provider Demographics
NPI:1356103873
Name:MARSTON, CHANDI DELYN (LMSW)
Entity type:Individual
Prefix:
First Name:CHANDI
Middle Name:DELYN
Last Name:MARSTON
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:224 W WAYNE ST
Mailing Address - Street 2:
Mailing Address - City:PAUL
Mailing Address - State:ID
Mailing Address - Zip Code:83347-8692
Mailing Address - Country:US
Mailing Address - Phone:208-316-2862
Mailing Address - Fax:
Practice Address - Street 1:414 N LINCOLN AVE STE 1
Practice Address - Street 2:
Practice Address - City:JEROME
Practice Address - State:ID
Practice Address - Zip Code:83338-2300
Practice Address - Country:US
Practice Address - Phone:208-324-5431
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-29
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLMSW-39033104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker