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Individual

MR. JOHN GREENE

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
LCSW

Contact information

Practice address
1720 N WESTGATE DR, BOISE, ID 83704-7164
(208) 954-0196
Mailing address
2514 N 21ST ST, BOISE, ID 83702-0602

Taxonomy

Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
31875
ID

Other

Enumeration date
04/05/2016
Last updated
04/05/2016
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