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General NPI Number Information
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NPI Number | 1114635836
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Entity Type | Individual
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Provider Name | LAURA DVORAK
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Gender | Female
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Dates
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Enumeration Date | 11/10/2022
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Last Update Date | 11/29/2025
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Provider Practice Location Address
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Address Line | 15-1477 2ND AVE
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City | KEAAU
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State | HI
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Zip | 96749-5039
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Country | US
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Telephone | 908-612-9390
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 10811
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City | HILO
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State | HI
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Zip | 96721-5811
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Country | US
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Telephone | 908-612-9390
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | LCSW-4869
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License Number State | HI
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