Healthcare Provider Details

I. General information

NPI: 1992032262
Provider Name (Legal Business Name): IRENE ANDREA BAXA YONASHIRO MSW, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/06/2009
Last Update Date: 01/11/2023
Certification Date: 01/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

459 PATTERSON RD 122 IY
HONOLULU HI
96819-1522
US

IV. Provider business mailing address

459 PATTERSON RD 122 IY
HONOLULU HI
96819-1522
US

V. Phone/Fax

Practice location:
  • Phone: 808-433-7648
  • Fax:
Mailing address:
  • Phone: 808-433-7648
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number478
License Number StateHI
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW-4018
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: