Healthcare Provider Details

I. General information

NPI: 1154383552
Provider Name (Legal Business Name): CLAUDIA LP WONG MAPC MAPT LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/03/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

91-2127 FORT WEAVER RD 2ND FLOOR
EVA BEACH HI
96706
US

IV. Provider business mailing address

PO BOX 235858
HONOLULU HI
96823
US

V. Phone/Fax

Practice location:
  • Phone: 808-581-0087
  • Fax: 808-833-5264
Mailing address:
  • Phone: 808-833-5264
  • Fax: 808-833-5264

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number007
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: