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General NPI Number Information
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NPI Number | 1386902930
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Entity Type | Individual
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Provider Name | MICHAEL N LAG L.C.S.W.
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Gender | Male
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Dates
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Enumeration Date | 05/01/2012
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Last Update Date | 12/29/2018
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Provider Practice Location Address
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Address Line | 105 N MARKET ST STE 102
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City | WAILUKU
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State | HI
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Zip | 96793-1752
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Country | US
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Telephone | 808-856-3149
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Fax | 808-242-1469
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Provider Business Mailing Address
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Address Line | 105 N MARKET ST STE 102
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City | WAILUKU
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State | HI
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Zip | 96793-1752
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Country | US
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Telephone | 808-856-3149
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Fax | 808-242-1469
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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 | 1678
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License Number State | HI
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Taxonomy #2
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 4152
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License Number State | HI
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