Healthcare Provider Details

I. General information

NPI: 1699384636
Provider Name (Legal Business Name): CASSIDY JOY DESHAZER MSW, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CASSIDY GALIMANIS

II. Dates (important events)

Enumeration Date: 07/27/2020
Last Update Date: 12/04/2023
Certification Date: 12/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2589 S FIVE MILE RD
BOISE ID
83709-2325
US

IV. Provider business mailing address

2589 S FIVE MILE RD
BOISE ID
83709-2325
US

V. Phone/Fax

Practice location:
  • Phone: 208-789-0417
  • Fax: 208-908-6404
Mailing address:
  • Phone: 208-789-0417
  • Fax: 208-908-6404

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW-42127
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: