Healthcare Provider Details

I. General information

NPI: 1013570936
Provider Name (Legal Business Name): CARMEN JEFFREY LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/16/2019
Last Update Date: 10/08/2026
Certification Date: 10/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 N CEDAR ST STE 110
POST FALLS ID
83854-6220
US

IV. Provider business mailing address

1201 LINCOLN WAY APT 107
COEUR D ALENE ID
83814-2384
US

V. Phone/Fax

Practice location:
  • Phone: 208-618-3474
  • Fax:
Mailing address:
  • Phone: 208-699-5673
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberLMSW38541
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: