Healthcare Provider Details

I. General information

NPI: 1336329119
Provider Name (Legal Business Name): MELANIE MARION OLIVEIRA LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MELANIE DORI MARION LCSW

II. Dates (important events)

Enumeration Date: 11/08/2007
Last Update Date: 12/12/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

354 ULUNIU ST # 203A
KAILUA HI
96734-2528
US

IV. Provider business mailing address

1 JARRETT WHITE RD
TRIPLER ARMY MEDICAL CENTER HI
96859-5001
US

V. Phone/Fax

Practice location:
  • Phone: 808-745-6123
  • Fax:
Mailing address:
  • Phone: 808-433-8600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberRC00050599
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLW60125884
License Number StateWA
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number3948
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: