Healthcare Provider Details

I. General information

NPI: 1700515335
Provider Name (Legal Business Name): STEVEN PESANKA LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2022
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11985 HERITAGE OAK PL
AUBURN CA
95603-2413
US

IV. Provider business mailing address

200 KANOELEHUA AVE PMB-347
HILO HI
96720
US

V. Phone/Fax

Practice location:
  • Phone: 530-889-0872
  • Fax:
Mailing address:
  • Phone: 808-743-5024
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW-4780
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: