Organization
GERICARE OF IDAHO, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BERNARD M BERLIN LCSW (OWNER)
(208) 830-6775
Entity
Organization
Contact information
Practice address
5442 S FARMHOUSE PL, BOISE, ID 83716-9016
(208) 830-6775
Mailing address
5310 WARD ROAD, SUITE 106, ARVADA, CO 80002-1829
(303) 278-7418
(888) 341-5050
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
LCSW-29777
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
LCS 10041
STATE LICENSE
CA
01
—
LCSW-29777
STATE LICENSE
ID
Enumeration date
04/09/2010
Last updated
04/09/2010
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