Healthcare Provider Details

I. General information

NPI: 1538995741
Provider Name (Legal Business Name): ALEXIS ROXANNE CONSIGLIO LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ALEXIS ROXANNE CONCEPCION LMSW

II. Dates (important events)

Enumeration Date: 09/12/2024
Last Update Date: 09/12/2024
Certification Date: 09/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

151 WAI CT UNIT 101
WAHIAWA HI
96786-5886
US

IV. Provider business mailing address

151 WAI CT UNIT 101
WAHIAWA HI
96786-5886
US

V. Phone/Fax

Practice location:
  • Phone: 808-433-8601
  • Fax:
Mailing address:
  • Phone: 973-330-6036
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number108628
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: