Provider Demographics
NPI:1700367133
Name:MOLINO, MADISON RAIN (LCSW)
Entity type:Individual
Prefix:
First Name:MADISON
Middle Name:RAIN
Last Name:MOLINO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:967 E PARKCENTER BLVD # 1079
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83706-6721
Mailing Address - Country:US
Mailing Address - Phone:801-633-7314
Mailing Address - Fax:
Practice Address - Street 1:5001 CHERRY GULCH LN
Practice Address - Street 2:
Practice Address - City:EMMETT
Practice Address - State:ID
Practice Address - Zip Code:83617-5123
Practice Address - Country:US
Practice Address - Phone:208-365-3437
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-23
Last Update Date:2024-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT11939680-35011041C0700X
ID439151041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical