Healthcare Provider Details

I. General information

NPI: 1053193797
Provider Name (Legal Business Name): JAMIE MELISSA RODRIGUEZ LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2023
Last Update Date: 04/15/2026
Certification Date: 04/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 WARD AVE STE 840
HONOLULU HI
96814-1610
US

IV. Provider business mailing address

1100 WARD AVE STE 840
HONOLULU HI
96814-1610
US

V. Phone/Fax

Practice location:
  • Phone: 808-522-4521
  • Fax: 808-522-3526
Mailing address:
  • Phone: 808-522-4521
  • Fax: 808-522-3526

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW-5357
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: