MEDICARE: RAMI ALEXANDRIA ROE LMSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	104100000X	Social Worker	3371885	ID

General Provider Information

NPI Number	:	1205706553
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RAMI ALEXANDRIA ROE LMSW

Provider Business Mailing Address
First Line	:	6146 W RIVA CAPRI ST
Second Line	:
City	:	MERIDIAN
State	:	ID
Zip	:	83646-1731
Country	:	US
Telephone Number	:	208-254-1112
Fax Number	:

Provider Business Practice Location Address
First Line	:	13477 W BLUEBONNET DR
Second Line	:
City	:	BOISE
State	:	ID
Zip	:	83713-1341
Country	:	US
Telephone Number	:	208-254-1112
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/10/2025
Last Update Date	:	11/10/2025

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