Provider Demographics
NPI:1356799118
Name:SIMIC, MAJA (LMSW)
Entity type:Individual
Prefix:
First Name:MAJA
Middle Name:
Last Name:SIMIC
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 1:930 N MAPLE GROVE RD APT D206
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83704-4817
Mailing Address - Country:US
Mailing Address - Phone:208-731-2941
Mailing Address - Fax:
Practice Address - Street 1:545 N BENJAMIN LN
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83704-9623
Practice Address - Country:US
Practice Address - Phone:208-322-1026
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-01
Last Update Date:2016-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLMSW-35805104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker