Healthcare Provider Details

I. General information

NPI: 1972151447
Provider Name (Legal Business Name): VARIETY SCHOOL OF HAWAII
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/28/2019
Last Update Date: 08/28/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

710 PALEKAUA ST
HONOLULU HI
96816-4755
US

IV. Provider business mailing address

710 PALEKAUA ST
HONOLULU HI
96816-4755
US

V. Phone/Fax

Practice location:
  • Phone: 808-732-2835
  • Fax:
Mailing address:
  • Phone: 808-732-2835
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: MS. STACIE S SATO-SUGIMOTO
Title or Position: ADMINISTRATOR
Credential: MHC, NCC
Phone: 808-732-2835