Provider Demographics
NPI:1508484155
Name:MANSFIELD, JANA MARIE (LCSW)
Entity type:Individual
Prefix:
First Name:JANA
Middle Name:MARIE
Last Name:MANSFIELD
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:JANA
Other - Middle Name:MARIE
Other - Last Name:HOFFMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:976 E VALENCIA ST
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83706-5536
Mailing Address - Country:US
Mailing Address - Phone:208-573-3778
Mailing Address - Fax:
Practice Address - Street 1:3527 S FEDERAL WAY STE 103
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83705-5228
Practice Address - Country:US
Practice Address - Phone:208-918-0070
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-10
Last Update Date:2024-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID439721041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical