Healthcare Provider Details

I. General information

NPI: 1619603222
Provider Name (Legal Business Name): KATHLEEN M CURTIS LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATHLEEN ANNE MCBRIDE LMSW

II. Dates (important events)

Enumeration Date: 07/26/2022
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12514 W MACUMBO ST
BOISE ID
83709-5169
US

IV. Provider business mailing address

12514 W MACUMBO ST
BOISE ID
83709-5169
US

V. Phone/Fax

Practice location:
  • Phone: 208-850-3542
  • Fax:
Mailing address:
  • Phone: 208-850-3542
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number8851227
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: