Healthcare Provider Details

I. General information

NPI: 1639381353
Provider Name (Legal Business Name): AMY J HARRINGTON LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMY J SMITH LMSW

II. Dates (important events)

Enumeration Date: 05/04/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2235 E 25TH ST STE 160
IDAHO FALLS ID
83404-7538
US

IV. Provider business mailing address

PO BOX 3051
IDAHO FALLS ID
83403-3051
US

V. Phone/Fax

Practice location:
  • Phone: 208-522-9812
  • Fax: 208-522-9859
Mailing address:
  • Phone: 208-525-2090
  • Fax: 208-525-2662

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberLMSW-24542
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: