Healthcare Provider Details

I. General information

NPI: 1346256138
Provider Name (Legal Business Name): HENRY A GRANDA LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4643B WAIMEA CANYON DRIVE
WAIMEA HI
96796
US

IV. Provider business mailing address

PO BOX 3990
LIHUE HI
96766-6990
US

V. Phone/Fax

Practice location:
  • Phone: 808-240-0154
  • Fax: 808-338-1606
Mailing address:
  • Phone: 808-240-0100
  • Fax: 808-245-8867

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW-3369
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: