=====================================================
General NPI Number Information
=====================================================
NPI Number | 1396918223
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ERICA NICOLE SCHOLNICK LCSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/11/2008
-----------------------------------------------------
Last Update Date | 11/30/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 970 N KALAHEO AVE A203
-----------------------------------------------------
City | KAILUA
-----------------------------------------------------
State | HI
-----------------------------------------------------
Zip | 96734-1866
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 808-529-1783
-----------------------------------------------------
Fax | 808-261-1120
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 970 N KALAHEO AVE A203
-----------------------------------------------------
City | KAILUA
-----------------------------------------------------
State | HI
-----------------------------------------------------
Zip | 96734-1866
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 808-529-1783
-----------------------------------------------------
Fax | 808-261-1120
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101Y00000X
-----------------------------------------------------
Taxonomy Name | Counselor
-----------------------------------------------------
License Number | 0755101
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 3746
-----------------------------------------------------
License Number State | HI
-----------------------------------------------------