Individual
PAULA MARIE GREEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LMSW
Contact information
Practice address
2275 W BROADWAY ST STE G, IDAHO FALLS, ID 83402-2902
(208) 524-7400
Mailing address
26 N 3167 E, IDAHO FALLS, ID 83402-5663
(208) 360-3344
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
LMSW-37036
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
412032666
—
ID
Enumeration date
09/21/2017
Last updated
09/21/2017
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