Individual provider Active NPI

Lenorah Tsetsakis, LMSW

  • Clinical Social Worker
  • Twin Falls, ID
National Provider Identifier
1679929350
Registry record updated Mar 27, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
LCSW-45406 Issued in ID
Practice address
2550 Addison Ave E
Twin Falls, ID 83301-6767
Phone
(208) 814-7750
Fax
(208) 814-7759
NPI assigned
May 11, 2016
Last updated
Mar 27, 2025By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 27, 2025

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Social Worker 104100000X LMSW-33852 ID
Social Worker 104100000X LCSW-45406 ID
Clinical Social Worker 1041C0700X LCSW-45406 ID Primary

Addresses

Primary practice location

2550 Addison Ave E
Twin Falls, ID 83301-6767

Mailing address

190 E Bannock St
Boise, ID 83712-6241
Phone (208) 814-4114

Other practice location 1

801 Pole Line Rd W
Twin Falls, ID 83301-5810
Phone (208) 814-4114

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ID
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.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250521001594 ID Practitioner - Clinical Social Worker 2961921184 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
LCSW-45406IDMDSocial Worker
LMSW-33852IDMDSocial Worker

Practice roles

OrganizationSpecialtyStatusNew patients
St Lukes Clinic-Treasure Valley LLC CurrentSince Mar 17, 2025 Accepting new patients
St Lukes Clinic-Treasure Valley LLC CurrentSince Mar 17, 2025 Accepting new patients

Locations

190 E Bannock St
Boise, ID 83712
Phone (208) 381-2378

610 W Hays St
Boise, ID 83702
Phone (208) 345-3530

Organizations & group practices 2

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

NPI Registry JSON

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

{
    "created_epoch": "1462924800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1743033600000",
    "number": "1679929350",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "190 E BANNOCK ST",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837126241",
            "telephone_number": "208-814-4114",
            "fax_number": "208-814-4907"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2550 ADDISON AVE E",
            "city": "TWIN FALLS",
            "state": "ID",
            "postal_code": "833016767",
            "telephone_number": "208-814-7750",
            "fax_number": "208-814-7759"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "801 Pole Line Rd W",
            "address_purpose": "LOCATION",
            "city": "Twin Falls",
            "state": "ID",
            "postal_code": "833015810",
            "country_code": "US",
            "telephone_number": "208-814-4114",
            "fax_number": "208-814-4709",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "TSETSAKIS",
        "first_name": "LENORAH",
        "credential": "LMSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-05-11",
        "last_updated": "2025-03-27",
        "certification_date": "2025-03-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "ID",
            "license": "LMSW-33852",
            "primary": false
        },
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "ID",
            "license": "LCSW-45406",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "ID",
            "license": "LCSW-45406",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Twin Falls, ID

Sources for this page

Verify at the official NPI Registry.