Healthcare Provider Details

I. General information

NPI: 1780487413
Provider Name (Legal Business Name): MAY ROQUE MSW, LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2025
Last Update Date: 04/09/2025
Certification Date: 04/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

92-461 MAKAKILO DR
KAPOLEI HI
96707-1270
US

IV. Provider business mailing address

92-461 MAKAKILO DR
KAPOLEI HI
96707-1270
US

V. Phone/Fax

Practice location:
  • Phone: 808-927-9538
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberLSW-3342
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: