Healthcare Provider Details

I. General information

NPI: 1962467340
Provider Name (Legal Business Name): ANDREA KUMURA LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/19/2006
Last Update Date: 11/08/2023
Certification Date: 11/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3828A CLAUDINE ST
HONOLULU HI
96816
US

IV. Provider business mailing address

4348 WAIALAE AVE # 526
HONOLULU HI
96816-5767
US

V. Phone/Fax

Practice location:
  • Phone: 808-203-4250
  • Fax:
Mailing address:
  • Phone: 808-203-4250
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLW00005796
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW115576
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW-3247
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: