Provider Demographics
NPI:1841079233
Name:BETTFREUND, MALERIE ERIN (LMSW)
Entity type:Individual
Prefix:
First Name:MALERIE
Middle Name:ERIN
Last Name:BETTFREUND
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1007 SUNSET DR
Mailing Address - Street 2:
Mailing Address - City:EMMETT
Mailing Address - State:ID
Mailing Address - Zip Code:83617-9545
Mailing Address - Country:US
Mailing Address - Phone:208-283-0257
Mailing Address - Fax:208-365-3578
Practice Address - Street 1:1202 E LOCUST ST
Practice Address - Street 2:
Practice Address - City:EMMETT
Practice Address - State:ID
Practice Address - Zip Code:83617-2715
Practice Address - Country:US
Practice Address - Phone:208-901-3206
Practice Address - Fax:208-365-3578
Is Sole Proprietor?:No
Enumeration Date:2023-09-25
Last Update Date:2023-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLMSW-42823104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker