Provider Demographics
NPI:1699989681
Name:CHAVARRIA, JUAN G (LMSW)
Entity type:Individual
Prefix:MR
First Name:JUAN
Middle Name:G
Last Name:CHAVARRIA
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:MR
Other - First Name:JUAN
Other - Middle Name:GUADALUPE
Other - Last Name:CHAVARRIA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMSW 26989
Mailing Address - Street 1:16 12TH AVE SO
Mailing Address - Street 2:SUITE 103
Mailing Address - City:NAMPA
Mailing Address - State:ID
Mailing Address - Zip Code:83651
Mailing Address - Country:US
Mailing Address - Phone:208-461-3720
Mailing Address - Fax:208-461-1787
Practice Address - Street 1:16 12TH AVE SO
Practice Address - Street 2:SUITE 103
Practice Address - City:NAMPA
Practice Address - State:ID
Practice Address - Zip Code:83651
Practice Address - Country:US
Practice Address - Phone:208-461-3720
Practice Address - Fax:208-461-1787
Is Sole Proprietor?:No
Enumeration Date:2007-05-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLMSW269891041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical