Healthcare Provider Details

I. General information

NPI: 1457433930
Provider Name (Legal Business Name): DOLLY ANNE BARNES LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

190 WEST MAIN STREET
KUNA ID
83634
US

IV. Provider business mailing address

1914 N SUMMERWIND PL
KUNA ID
83634-3463
US

V. Phone/Fax

Practice location:
  • Phone: 208-922-9001
  • Fax: 208-922-3778
Mailing address:
  • Phone: 208-922-9001
  • Fax: 208-922-3778

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW-27072
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: