Healthcare Provider Details

I. General information

NPI: 1972982437
Provider Name (Legal Business Name): MATTHEW TODD POSLUSZNY LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/29/2015
Last Update Date: 11/28/2023
Certification Date: 11/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 S 23RD ST
BOISE ID
83702-9100
US

IV. Provider business mailing address

211 16TH AVE N
NAMPA ID
83687-4058
US

V. Phone/Fax

Practice location:
  • Phone: 208-344-3512
  • Fax: 208-344-4898
Mailing address:
  • Phone: 208-344-3512
  • Fax: 208-344-4898

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW-36287
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: