Healthcare Provider Details

I. General information

NPI: 1083861595
Provider Name (Legal Business Name): ARLENE MIRANDA-FUNTANILLA QCSW, LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ARLENE MIRANDA QCSW

II. Dates (important events)

Enumeration Date: 08/26/2008
Last Update Date: 08/26/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

98-259 UALO ST APT. P-2
AIEA HI
96701-4635
US

IV. Provider business mailing address

98-259 UALO ST APT. P-2
AIEA HI
96701-4635
US

V. Phone/Fax

Practice location:
  • Phone: 808-386-2074
  • Fax:
Mailing address:
  • Phone: 808-386-2074
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberLSW-615
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: