Healthcare Provider Details

I. General information

NPI: 1992319164
Provider Name (Legal Business Name): ABIGAIL SOLOMON LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/03/2020
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3071 E FRANKLIN RD # 201
MERIDIAN ID
83642-2376
US

IV. Provider business mailing address

3071 E FRANKLIN RD # 201
MERIDIAN ID
83642-2376
US

V. Phone/Fax

Practice location:
  • Phone: 208-807-2877
  • Fax: 208-807-2877
Mailing address:
  • Phone: 208-807-2877
  • Fax: 208-807-2877

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW-8911118
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: