Healthcare Provider Details

I. General information

NPI: 1801579784
Provider Name (Legal Business Name): JENNA MARIE WARBRITTON LCSW, MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/08/2023
Last Update Date: 05/20/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3905 S WOODCRAFT AVE
BOISE ID
83716-7155
US

IV. Provider business mailing address

3905 S WOODCRAFT AVE
BOISE ID
83716-7155
US

V. Phone/Fax

Practice location:
  • Phone: 719-648-7228
  • Fax:
Mailing address:
  • Phone: 719-648-7228
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number138719
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: