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General NPI Number Information
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NPI Number | 1396108791
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Entity Type | Organization
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Legal Business Name | EXPANDING HORIZONS HAWAII
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Dates
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Enumeration Date | 04/01/2016
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Last Update Date | 05/10/2016
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Provider Practice Location Address
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Address Line | 45-955 KAMEHAMEHA HWY STE 206
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City | KANEOHE
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State | HI
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Zip | 96744-3293
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Country | US
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Telephone | 808-222-8057
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Fax |
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Provider Business Mailing Address
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Address Line | 1617 MILLER ST APT 7
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City | HONOLULU
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State | HI
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Zip | 96813-1898
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Country | US
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Telephone | 808-222-8057
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Fax |
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Authorized Official
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Title or Position | CLINICAL SOCIAL WORKER
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Name | WENDY SIMONETTI
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Credential | LCSW
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Telephone | 808-222-8057
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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-3575
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License Number State | HI
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