Provider Demographics
NPI:1871612036
Name:FRUGOLI, CARYL M (LCSW LPN EAP)
Entity type:Individual
Prefix:
First Name:CARYL
Middle Name:M
Last Name:FRUGOLI
Suffix:
Gender:F
Credentials:LCSW LPN EAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:548 LOMAX
Mailing Address - Street 2:
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83401-2634
Mailing Address - Country:US
Mailing Address - Phone:208-524-3733
Mailing Address - Fax:208-524-3738
Practice Address - Street 1:548 LOMAX
Practice Address - Street 2:
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83401-2634
Practice Address - Country:US
Practice Address - Phone:208-524-3733
Practice Address - Fax:208-524-3738
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-28
Last Update Date:2007-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCSW26736101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health