Healthcare Provider Details

I. General information

NPI: 1063822369
Provider Name (Legal Business Name): CORALEE KOBASHIGAWA LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/07/2014
Last Update Date: 07/10/2023
Certification Date: 07/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

459 PATTERSON RD
HONOLULU HI
96819-1522
US

IV. Provider business mailing address

3390 ALA LAULANI ST
HONOLULU HI
96818-2837
US

V. Phone/Fax

Practice location:
  • Phone: 808-433-0610
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW-4532
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: