Healthcare Provider Details

I. General information

NPI: 1174514426
Provider Name (Legal Business Name): KAREN SUE BAYARD LCSW QCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/03/2005
Last Update Date: 04/18/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

404 KUEHU ST ATTN: OPENING DOORS TO CHANGE, LLC
KAPOLEI HI
96707-4500
US

IV. Provider business mailing address

404 KUEHU ST
KAPOLEI HI
96707-4500
US

V. Phone/Fax

Practice location:
  • Phone: 808-260-9844
  • Fax: 808-260-9920
Mailing address:
  • Phone: 808-260-9844
  • Fax: 808-260-9920

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number3297
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: