MARY KELLEEN BERMENSOLO (NPI# 1659420693) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1659420693 |
| Entity Type | Individual |
| Full Name | MARY KELLEEN BERMENSOLO |
| Credential | LCSW |
| Practice Address |
410 S Orchard St Ste 132 Boise ID 83705-1288 |
| Practice Telephone | 2084126683 |
| Practice Fax Number | 2088882215 |
| Mailing Telephone | 2084126683 |
| Mailing Fax Number | 2088882215 |
| Enumeration Date | 2007-01-09 |
| Last Update Date | 2019-01-16 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1041C0700X |
Social Worker Specialization: Clinical |
LCSW492 | ID | Behavioral Health & Social Service Providers |
| Street Address |
410 S ORCHARD ST STE 132 |
| City | BOISE |
| State | ID |
| Zip Code | 83705-1288 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1275634776 | Patricia Marie Alexander | Counselor | 410 S Orchard St, Suite 132, Boise, ID 83705-1260 | 2006-09-26 |
| 1376094839 | Tiffany Myers | Counselor | 410 S Orchard St, 184, Boise, ID 83705-1260 | 2016-10-19 |
| 1891171088 | Melissa Jimenez Chalom | Counselor | 410 S Orchard St, Suite 184, Boise, ID 83705-1260 | 2015-08-10 |
| 1992193866 | Joseph Seiders | Social Worker | 410 S Orchard St, Suite 124a, Boise, ID 83705-1260 | 2014-12-30 |
| 1427312834 | Marissa Nickel | Social Worker | 410 S Orchard St, Ste. 232, Boise, ID 83705-1260 | 2012-06-29 |
| 1396865432 | Lutheran Community Services Nw | Counselor | 410 S Orchard St, Suite 124, Boise, ID 83705-1260 | 2007-03-30 |
| 1295894111 | Heather Leigh Donahue | Counselor | 410 S Orchard St, Boise, ID 83705-1260 | 2006-12-06 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1053938779 | Halo Health Services LLC | Community/Behavioral Health | 1111 S Orchard St, Boise, Id 83705, Boise, ID 83705 | 2020-06-29 |
| 1598265860 | Felica Jo Duce | Counselor | 921 S Orchard St Ste 103, Boise, ID 83705 | 2018-02-13 |
| 1215364278 | Erica Zelickowski | Pharmacist | 1653 S Vista Avenue, Boise, ID 83705 | 2013-10-04 |
| 1952655490 | Aida Dizdar-barac | Social Worker | 2273 S. Vista Avenue, Suite 190, Boise, ID 83705 | 2012-11-06 |
| 1033461033 | Julie Marie Meek | Social Worker | 3324 W Elder St, Boise, ID 83705 | 2012-10-15 |
| 1568761112 | Berkeley Fraser | Pharmacist | 3527 S Federal Way Suite 104, Boise, ID 83705 | 2011-03-22 |
| 1922311042 | Amber Vania | Family Medicine | 4971 W. Overland Road, Boise, ID 83705 | 2010-07-18 |
| 1295056836 | Cherise M Wetzel | Social Worker | 1625 S Eagleson Rd, B1, Boise, ID 83705 | 2010-06-17 |
| 1558685305 | Rae Ann Norell | Social Worker | 2273 S. Vista Ave, #190 Treasure Valley Community Counseling Services, Boise, ID 83705 | 2010-03-23 |
| 1164679932 | Oreana Harless | Social Worker | 2550 South Vista Ave, Boise, ID 83705 | 2008-08-25 |
| Find all providers in zip 83705 | ||||
| Taxonomy Code | 1041C0700X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Social Worker |
| Specialization | Clinical |
| A social worker who holds a master’s or doctoral degree in social work from an accredited school of social work in addition to at least two years of post-master’s supervised experience in a clinical setting. The social worker must be licensed, certified, or registered at the clinical level in the jurisdiction of practice. A clinical social worker provides direct services, including interventions focused on interpersonal interactions, intrapsychic dynamics, and life management issues. Clinical social work services are based on bio-psychosocial perspectives. Services consist of assessment, diagnosis, treatment (including psychotherapy and counseling), client-centered advocacy, consultation, evaluation, and prevention of mental illness, emotional, or behavioral disturbances. |
| Notes: Source: National Association of Social Workers, 2008 [7/1/2009: definition modified] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1679171961 | Jill Michelle Chonody | Social Worker | 3134 S Waterbury Ln, Boise, ID 83706-5222 | 2020-10-09 |
| 1750999777 | Deanna Armenia Brent | Social Worker | 7450 W Althea Ct, Boise, ID 83709-1777 | 2020-07-15 |
| 1013533231 | Sylvia Oh | Social Worker | 2118 S Latah St, Boise, ID 83705-3947 | 2020-06-23 |
| 1417577412 | Stacey Titus Pllc | Social Worker | 5440 W Franklin Rd Ste 201, Boise, ID 83705-6434 | 2020-04-20 |
| 1447888656 | Berndt and Associates In Psychcare LLC | Social Worker | 4477 W Emerald St Ste C275, Boise, ID 83706-2078 | 2020-04-01 |
| 1528690773 | Marc Adrian Dominguez | Social Worker | 1299 N Orchard St Ste 110, Boise, ID 83706-2266 | 2020-02-06 |
| 1235774407 | Wildflower Intuitive Center, LLC | Social Worker | 4696 W Overland Rd Ste 276, Boise, ID 83705-2877 | 2019-11-12 |
| 1558903328 | Daring In Idaho, LLC | Social Worker | 413 N Allumbaugh Street, Suite 102, Boise, ID 83704 | 2019-10-14 |
| 1821550203 | Alturas Counseling | Social Worker | 204 S Cole Rd, Boise, ID 83709-0934 | 2019-04-03 |
| 1750859856 | Jani Lynn Belcoe | Social Worker | 3029 N 32nd St, Boise, ID 83703-5001 | 2018-11-06 |
| Find all providers in BOISE | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.