Healthcare Provider Details

I. General information

NPI: 1669870010
Provider Name (Legal Business Name): NATALIE KEOMAILANI ORNELLAS CASTRO LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MS. NATALIE KEOMAILANI ORNELLAS

II. Dates (important events)

Enumeration Date: 12/17/2014
Last Update Date: 09/28/2021
Certification Date: 09/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 BRANNON ROAD BUILDING 674 - ROOM 2032 - DESMOND DOSS HEALTH CLINIC
SCHOFIELD BARRACKS HI
96857-5460
US

IV. Provider business mailing address

TRIPLER ARMY MEDICAL CENTER CREDENTIALING DEPARTMENT 1 JARRETT WHITE ROAD
TRIPLER AMC HI
96859-5000
US

V. Phone/Fax

Practice location:
  • Phone: 808-433-8134
  • Fax: 808-433-8597
Mailing address:
  • Phone: 808-433-8134
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number3970
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: