Provider Demographics
NPI:1174955850
Name:LUMIA, DEENA CHRISTINE (BSW, LCSW)
Entity type:Individual
Prefix:MS
First Name:DEENA
Middle Name:CHRISTINE
Last Name:LUMIA
Suffix:
Gender:F
Credentials:BSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2313 W BELLA ST
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83702-0423
Mailing Address - Country:US
Mailing Address - Phone:208-629-7733
Mailing Address - Fax:208-343-8475
Practice Address - Street 1:2313 W BELLA ST
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83702-0423
Practice Address - Country:US
Practice Address - Phone:208-629-7733
Practice Address - Fax:208-343-8475
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-05
Last Update Date:2017-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID362891041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID8082880Medicaid