Healthcare Provider Details

I. General information

NPI: 1730399262
Provider Name (Legal Business Name): ROBBYN K TAKEUCHI LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/23/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1805 PALAMOI ST
PEARL CITY HI
96782-1564
US

IV. Provider business mailing address

1805 PALAMOI ST
PEARL CITY HI
96782-1564
US

V. Phone/Fax

Practice location:
  • Phone: 808-291-2942
  • Fax: 808-455-6149
Mailing address:
  • Phone: 808-291-2942
  • Fax: 808-455-6149

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW3236
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: