Provider Demographics
NPI:1720490659
Name:LIVERNOIS, NOELLE LUFKIN (MSW, LICSW)
Entity Type:Individual
Prefix:
First Name:NOELLE
Middle Name:LUFKIN
Last Name:LIVERNOIS
Suffix:
Gender:F
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:NOELLE
Other - Middle Name:ELIZABETH
Other - Last Name:LUFKIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:107 S DIVISION ST
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99202-1510
Mailing Address - Country:US
Mailing Address - Phone:509-838-4651
Mailing Address - Fax:
Practice Address - Street 1:107 S DIVISION ST
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99202-1510
Practice Address - Country:US
Practice Address - Phone:509-838-4651
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-27
Last Update Date:2019-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW60908861104100000X, 1041C0700X
WALW609694591041C0700X
FLSW138391041C0700X
WASC608619751041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1720490659Medicaid