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General NPI Number Information
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NPI Number | 1114277282
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Entity Type | Individual
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Provider Name | LAURA CATHERINE MOA NISHIZAKI LCSW
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Gender | Female
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Dates
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Enumeration Date | 09/14/2012
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Last Update Date | 04/30/2024
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Provider Practice Location Address
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Address Line | 1301 PUNCHBOWL ST
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City | HONOLULU
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State | HI
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Zip | 96813-2402
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Country | US
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Telephone | 808-691-7336
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Fax | 808-691-4305
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Provider Business Mailing Address
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Address Line | 91-1493 LOILOI LOOP
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City | EWA BEACH
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State | HI
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Zip | 96706-4875
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Country | US
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Telephone | 808-391-2524
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | LSW2118
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License Number State | HI
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | LCSW4645
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License Number State | HI
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