Healthcare Provider Details

I. General information

NPI: 1851334338
Provider Name (Legal Business Name): ALTON T. TAMASHIRO LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/13/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3627 KILAUEA AVE ROOM 101
HONOLULU HI
96816-2317
US

IV. Provider business mailing address

95-704 KELEWAA ST
MILILANI HI
96789-2938
US

V. Phone/Fax

Practice location:
  • Phone: 808-453-6558
  • Fax: 808-453-5940
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW-3343
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: