Provider Information for 1417094012
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LAURA SOFIA ACERO LCSW-R
Sex: Female
NPI: 1417094012
Last Updated: 2021-04-06
Certification Date: 2021-03-17
Certification Date: 2021-03-17
Details
| Name | Value | ||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| NPI | 1417094012 | ||||||||||||||
| Enumeration Date | 2007-01-31 | ||||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||||
| Sole Proprietor | NO | ||||||||||||||
| Status | Active | ||||||||||||||
| Mailing Address | 794 EASTLAND DR TWIN FALLS, ID 83301-6856 United States Phone: 208-737-6718 | Fax: | ||||||||||||||
| Primary Practice Address | 218 W NEZ PERCE JEROME, ID 83338-5077 United States Phone: 208-324-3471 | Fax: | ||||||||||||||
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