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Individual

MS. JESSICA DEE MAITRI

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
LCSW

Contact information

Practice address
500 W IDAHO ST STE 250, BOISE, ID 83702-5756
(208) 863-8210
Mailing address
PO BOX 1533, BOISE, ID 83701-1533
(208) 863-8210

Taxonomy

Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
LCSW-32437
ID
104100000X
Social Worker
LMSW-30582
ID

Other

Enumeration date
12/27/2011
Last updated
07/16/2022
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