Provider Demographics
NPI:1154179034
Name:RAIMONDI-MUSSER, MEGAN (LCSW)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:
Last Name:RAIMONDI-MUSSER
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 1:2500 N 32ND ST
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83703-5508
Mailing Address - Country:US
Mailing Address - Phone:208-917-2462
Mailing Address - Fax:
Practice Address - Street 1:401 W IDAHO ST # LL-1
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83702-6042
Practice Address - Country:US
Practice Address - Phone:208-917-2462
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-07
Last Update Date:2024-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCSW400661041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical