Provider Demographics
NPI:1174699482
Name:SORENSON, DARLENE CAROL (LCSW)
Entity type:Individual
Prefix:
First Name:DARLENE
Middle Name:CAROL
Last Name:SORENSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1620 NORTHWEST BLVD 201
Mailing Address - Street 2:
Mailing Address - City:COUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83814
Mailing Address - Country:US
Mailing Address - Phone:208-704-5358
Mailing Address - Fax:208-765-2558
Practice Address - Street 1:1620 NORTHWEST BLVD 201
Practice Address - Street 2:
Practice Address - City:COUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814
Practice Address - Country:US
Practice Address - Phone:208-704-5358
Practice Address - Fax:208-765-2558
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID13681041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID000010032217OtherREGENCE BLUE SHIELD
IDL0981OtherBLUE CROSS
1692264Medicare ID - Type Unspecified