Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Mary Kelleen Bermensolo, LCSW

Individual provider Clinical Social Worker · NPI 1659420693

Mary Kelleen Bermensolo, LCSW is a Clinical Social Worker in Boise, Idaho. Qualified in 1984, 42 years ago. Practices as a sole proprietor, accepts Medicare assignment and offers telehealth. Licensed in Idaho.

Years since qualifying
42
Licensed in
ID
In the registry since
2007
What do these letters mean?
LCSW — Licensed Clinical Social Worker
A social worker licensed to diagnose and treat mental health conditions independently.

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Practice location Address checks out

410 S Orchard St Ste 132
Boise, ID 83705-1288
Phone: (208) 412-6683
Fax: (208) 888-2215
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Clinical Social Worker (primary) Taxonomy 1041C0700X · Licence LCSW492 (ID)

Record details

NPI number1659420693
Entity typeIndividual (Type 1)
GenderFemale
Credentials LCSW
Sole proprietorYes
NPI enumeratedJanuary 9, 2007
Last updated in NPPESJanuary 16, 2019

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyCLINICAL SOCIAL WORKER
Medical schoolOTHER
Graduated 1984 (42 years in practice)
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
TelehealthOffers telehealth services

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