Provider Demographics
NPI:1699384636
Name:DESHAZER, CASSIDY JOY (MSW, LCSW)
Entity type:Individual
Prefix:
First Name:CASSIDY
Middle Name:JOY
Last Name:DESHAZER
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:CASSIDY
Other - Middle Name:
Other - Last Name:GALIMANIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2589 S FIVE MILE RD
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83709-2325
Mailing Address - Country:US
Mailing Address - Phone:208-789-0417
Mailing Address - Fax:208-908-6404
Practice Address - Street 1:2589 S FIVE MILE RD
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83709-2325
Practice Address - Country:US
Practice Address - Phone:208-789-0417
Practice Address - Fax:208-908-6404
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-27
Last Update Date:2023-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCSW-421271041C0700X
ID421271041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical