MEDICARE: RACHEL SAMANTHA DONAHUE EBERT LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	104100000X	Social Worker	2030	HI
2	1041C0700X	Clinical Social Worker	2030	HI

General Provider Information

NPI Number	:	1376986067
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RACHEL SAMANTHA DONAHUE EBERT LCSW

Provider Business Mailing Address
First Line	:	245 N KUKUI ST STE 102A
Second Line	:
City	:	HONOLULU
State	:	HI
Zip	:	96817-3921
Country	:	US
Telephone Number	:	808-672-2932
Fax Number	:

Provider Business Practice Location Address
First Line	:	245 N KUKUI ST STE 102A
Second Line	:
City	:	HONOLULU
State	:	HI
Zip	:	96817-3921
Country	:	US
Telephone Number	:	808-672-2932
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/11/2013
Last Update Date	:	09/11/2023

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