Dominique Davi Juarez, LCSW-39611

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

LCSW-39611 Issued in ID

Practice address

314 Badiola St
Caldwell, ID 83605-4389

Phone

(208) 454-8389

NPI assigned

Oct 21, 2015

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1445385600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1594080000000",
    "number": "1871965533",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "515 E HERITAGE PARK ST",
            "city": "MERIDIAN",
            "state": "ID",
            "postal_code": "836466293",
            "telephone_number": "208-371-8420"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "314 BADIOLA ST",
            "city": "CALDWELL",
            "state": "ID",
            "postal_code": "836054389",
            "telephone_number": "208-454-8389"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "8950 W Emerald St",
            "address_2": "Suite 178",
            "address_purpose": "LOCATION",
            "city": "Boise",
            "state": "ID",
            "postal_code": "837044854",
            "country_code": "US",
            "telephone_number": "208-376-7083",
            "fax_number": "208-321-5069",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JUAREZ",
        "first_name": "DOMINIQUE",
        "middle_name": "DAVI",
        "credential": "LCSW-39611",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-10-21",
        "last_updated": "2020-07-07",
        "certification_date": "2020-07-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "ID",
            "license": "LCSW-39611",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": ".",
            "identifier": "LCSW39611",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Corinna Jones
• Paul Jones
• Sarah Suzanne Jones, LCSW
• Cheryl L Jorgenson, R.D., L.D
• Anayeli Juarez
• Carol Diane Julius, RD LD
• Eugene Kaplan, M.D.
• Sandra Kasumovic, PA-C
• Jacqueline K Kavila, PHARMD
• Ke Therapy PLLC

• Clinical Social Worker in Caldwell, ID
• Providers in Caldwell, ID by specialty
• Clinical Social Worker in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 7, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.