Provider Demographics
NPI:1700967221
Name:CURTIS, AMY CAROLINE (LCSW, CAP)
Entity Type:Individual
Prefix:MS
First Name:AMY
Middle Name:CAROLINE
Last Name:CURTIS
Suffix:
Gender:F
Credentials:LCSW, CAP
Other - Prefix:MS
Other - First Name:AMY
Other - Middle Name:CAROLINE
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW, CAP
Mailing Address - Street 1:2625 N WAGGLE PL
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-9017
Mailing Address - Country:US
Mailing Address - Phone:208-898-0608
Mailing Address - Fax:
Practice Address - Street 1:10740 EAST FAIRVIEW AVE.
Practice Address - Street 2:SUITE 100
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83713
Practice Address - Country:US
Practice Address - Phone:208-376-0191
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID12211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical