Healthcare Provider Details

I. General information

NPI: 1396114039
Provider Name (Legal Business Name): ETSUKO YAMAGUCHI FOSTER LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2015
Last Update Date: 05/03/2023
Certification Date: 05/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2239 N SCHOOL ST
HONOLULU HI
96819-2539
US

IV. Provider business mailing address

2239 N SCHOOL ST
HONOLULU HI
96819-2539
US

V. Phone/Fax

Practice location:
  • Phone: 808-791-9425
  • Fax: 808-847-1144
Mailing address:
  • Phone: 808-791-9425
  • Fax: 808-847-1144

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number2246
License Number StateHI
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number4571
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: