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General NPI Number Information
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NPI Number | 1659080364
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Entity Type | Organization
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Legal Business Name | LEE KATSUMOTO LACERDO, LLC
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Dates
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Enumeration Date | 11/21/2022
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Last Update Date | 11/21/2022
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Provider Practice Location Address
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Address Line | 94-1036 WAIPIO UKA ST STE 109
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City | WAIPAHU
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State | HI
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Zip | 96797-4050
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Country | US
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Telephone | 808-291-2634
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1570
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City | PEARL CITY
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State | HI
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Zip | 96782-8570
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Country | US
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Telephone | 808-291-2634
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MRS. LEE LACERDO
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Credential | LCSW
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Telephone | 808-291-2634
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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 |
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License Number State |
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