Healthcare Provider Details

I. General information

NPI: 1609763291
Provider Name (Legal Business Name): AMANDA KAY DAMIAN LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2025
Last Update Date: 06/23/2025
Certification Date: 06/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

683 WAIANAE AVE BLDG O
WAHIAWA HI
96786-5879
US

IV. Provider business mailing address

683 WAIANAE AVE BLDG O
WAHIAWA HI
96786
US

V. Phone/Fax

Practice location:
  • Phone: 808-433-8601
  • Fax:
Mailing address:
  • Phone: 808-953-9005
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number116077
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: