Individual
DOMINIQUE DAVI JUAREZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LCSW-39611
Contact information
Practice address
314 BADIOLA ST, CALDWELL, ID 83605-4389
(208) 454-8389
Mailing address
515 E HERITAGE PARK ST, MERIDIAN, ID 83646-6293
(208) 371-8420
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
LCSW-39611
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
LCSW39611
.
ID
Enumeration date
10/21/2015
Last updated
07/07/2020
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