Provider Demographics
NPI:1366997322
Name:BELMONT, JENNIFER AMBER (LCSW)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:AMBER
Last Name:BELMONT
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 1:8680 N WAYNE DR.
Mailing Address - Street 2:SUITE A
Mailing Address - City:HAYDEN
Mailing Address - State:ID
Mailing Address - Zip Code:83835
Mailing Address - Country:US
Mailing Address - Phone:208-627-7818
Mailing Address - Fax:208-625-2070
Practice Address - Street 1:8680 N WAYNE DR
Practice Address - Street 2:SUITE A
Practice Address - City:HAYDEN
Practice Address - State:ID
Practice Address - Zip Code:83835
Practice Address - Country:US
Practice Address - Phone:208-627-7818
Practice Address - Fax:844-803-7399
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-19
Last Update Date:2023-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLMSW-35884104100000X
IDLCSW384731041C0700X
IDLCSW-384731041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2071936Medicaid