Provider Demographics
NPI:1780307942
Name:KAALI, MARISA A (LMSW)
Entity type:Individual
Prefix:
First Name:MARISA
Middle Name:A
Last Name:KAALI
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:MARISSA
Other - Middle Name:ABB
Other - Last Name:HILL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 9
Mailing Address - Street 2:
Mailing Address - City:NAMPA
Mailing Address - State:ID
Mailing Address - Zip Code:83653-0009
Mailing Address - Country:US
Mailing Address - Phone:208-377-9669
Mailing Address - Fax:208-377-1028
Practice Address - Street 1:400 N ALLUMBAUGH ST
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83704-9209
Practice Address - Country:US
Practice Address - Phone:208-377-9669
Practice Address - Fax:208-377-1028
Is Sole Proprietor?:No
Enumeration Date:2022-09-22
Last Update Date:2022-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLMSW-41757104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker