Individual
MR. BENJAMIN RAMON LARA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LMSW
Contact information
Practice address
9196 W BARNES DR, BOISE, ID 83709-1552
(208) 433-0400
(208) 433-5271
Mailing address
5859 MILLWRIGHT AVE, GARDEN CITY, ID 83714-1665
(208) 433-0400
(208) 433-5271
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
32322
ID
Other
Enumeration date
08/29/2013
Last updated
08/29/2013
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