Healthcare Provider Details

I. General information

NPI: 1063146413
Provider Name (Legal Business Name): KAINANI M DERRICKSON LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2022
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1025 WAIMANU ST APT 211
HONOLULU HI
96814-3427
US

IV. Provider business mailing address

1521 ALEXANDER ST APT 903
HONOLULU HI
96822-4961
US

V. Phone/Fax

Practice location:
  • Phone: 808-797-5043
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW-5436
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: