Provider Demographics
NPI:1306280003
Name:SUAREZ, RENAE MICHELLE (LMSW)
Entity type:Individual
Prefix:MRS
First Name:RENAE
Middle Name:MICHELLE
Last Name:SUAREZ
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 1:2235 E 25TH ST
Mailing Address - Street 2:SUITE 185
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83404-7519
Mailing Address - Country:US
Mailing Address - Phone:208-390-1147
Mailing Address - Fax:208-552-8847
Practice Address - Street 1:2235 E 25TH ST
Practice Address - Street 2:SUITE 185
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83404-7519
Practice Address - Country:US
Practice Address - Phone:208-390-1147
Practice Address - Fax:208-552-8847
Is Sole Proprietor?:No
Enumeration Date:2013-04-24
Last Update Date:2013-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLMSW-32842104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker