Healthcare Provider Details

I. General information

NPI: 1154580892
Provider Name (Legal Business Name): CHRISTIANE E. MAGERA LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2008
Last Update Date: 01/19/2021
Certification Date: 01/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 W REMINGTON RD
ATHOL ID
83801-8506
US

IV. Provider business mailing address

7 W REMINGTON RD
ATHOL ID
83801-8506
US

V. Phone/Fax

Practice location:
  • Phone: 208-819-7787
  • Fax:
Mailing address:
  • Phone: 208-819-7787
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW-31260
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: