Provider Demographics
NPI:1912713603
Name:MAGNI, EMILY SARAH (LMSW)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:SARAH
Last Name:MAGNI
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 1:3475 SUMMIT DR
Mailing Address - Street 2:
Mailing Address - City:POCATELLO
Mailing Address - State:ID
Mailing Address - Zip Code:83201-8010
Mailing Address - Country:US
Mailing Address - Phone:917-359-9292
Mailing Address - Fax:
Practice Address - Street 1:3475 SUMMIT DR
Practice Address - Street 2:
Practice Address - City:POCATELLO
Practice Address - State:ID
Practice Address - Zip Code:83201-8010
Practice Address - Country:US
Practice Address - Phone:917-359-9292
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-06
Last Update Date:2024-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY125492-011041C0700X
IDLMSW-444211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical