=====================================================
General NPI Number Information
=====================================================
NPI Number | 1386445062
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | NAITIA AUELUA CLINICAL SOCIAL WORK
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/20/2025
-----------------------------------------------------
Last Update Date | 03/20/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 56-1089 KAMEHAMEHA HIGHWAY
-----------------------------------------------------
City | KAHUKU
-----------------------------------------------------
State | HI
-----------------------------------------------------
Zip | 96731
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 808-347-1246
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 55-692 KAMEHAMEHA HWY
-----------------------------------------------------
City | LAIE
-----------------------------------------------------
State | HI
-----------------------------------------------------
Zip | 96762-1210
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 808-457-9522
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------