Individual provider Active NPI

Casey Margaret Sullivan, LMSW

  • Clinical Social Worker
  • Boise, ID
National Provider Identifier
1235754128
Registry record updated Jan 10, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
LCSW-44226 Issued in ID
Practice address
6533 W Emerald St
Boise, ID 83704-8737
Phone
(208) 367-2126
Fax
(208) 367-7410
NPI assigned
Jun 16, 2020
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 10, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X LCSW-44226 ID Primary
Social Worker 104100000X LMSW-39715 ID

Addresses

Primary practice location

6533 W Emerald St
Boise, ID 83704-8737

Mailing address

PO Box 190930
Boise, ID 83719-0930
Phone (208) 367-2126

Other practice location 1

7941 W Rifleman St
Boise, ID 83704-9001
Phone (208) 895-7950

Other practice location 2

847 Parkcentre Way Ste 7
Nampa, ID 83651-1794
Phone (208) 229-6050

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file
Eligible to order & refer
  • Part B services: No
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
LMSW-39715IDMDSocial Worker
LCSW-44226IDMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Saint Alphonsus Regional Medical Center Inc CurrentSince Mar 1, 2024 Accepting new patients
Saint Alphonsus Regional Medical Center Inc Clinical Current Accepting new patients
Saint Alphonsus Regional Medical Center Inc CurrentSince Mar 1, 2024 Accepting new patients
Ashwood Recovery LLC Past Accepting new patients
Ashwood Recovery LLC Past Accepting new patients

Locations

6533 W Emerald St
Boise, ID 83704
Phone (208) 302-5200

3025 W Cherry Ln
Ste B
Meridian, ID 83642
Phone (208) 302-6400

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1592265600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1704844800000",
    "number": "1235754128",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 190930",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837190930",
            "telephone_number": "208-367-2126",
            "fax_number": "208-367-7410"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6533 W EMERALD ST",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837048737",
            "telephone_number": "208-367-2126",
            "fax_number": "208-367-7410"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "7941 W Rifleman St",
            "address_purpose": "LOCATION",
            "city": "Boise",
            "state": "ID",
            "postal_code": "837049001",
            "country_code": "US",
            "telephone_number": "208-895-7950",
            "fax_number": "855-212-5682",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "847 Parkcentre Way Ste 7",
            "address_purpose": "LOCATION",
            "city": "Nampa",
            "state": "ID",
            "postal_code": "836511794",
            "country_code": "US",
            "telephone_number": "208-229-6050",
            "fax_number": "855-212-5682",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SULLIVAN",
        "first_name": "CASEY",
        "middle_name": "MARGARET",
        "credential": "LMSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-06-16",
        "last_updated": "2024-01-10",
        "certification_date": "2024-01-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "ID",
            "license": "LCSW-44226",
            "primary": true
        },
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "ID",
            "license": "LMSW-39715",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Boise, ID

Sources for this page

Verify at the official NPI Registry.