Healthcare Provider Details

I. General information

NPI: 1205133956
Provider Name (Legal Business Name): KELLY HEE LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/15/2011
Last Update Date: 04/10/2024
Certification Date: 07/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1334 9TH AVE
HONOLULU HI
96816-2615
US

IV. Provider business mailing address

1334 9TH AVE
HONOLULU HI
96816-2615
US

V. Phone/Fax

Practice location:
  • Phone: 925-708-3692
  • Fax:
Mailing address:
  • Phone: 925-708-3692
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number78388
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: