MEDICARE: MRS. MAISA LEILANI ZIEGLER 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
2	101YM0800X	Mental Health Counselor	LCSW-4729	HI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	12157401	OTHER	HI	AWSB

General Provider Information

NPI Number	:	1730724345
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MAISA LEILANI ZIEGLER LCSW

Provider Business Mailing Address
First Line	:	HO'OMAU THERAPY, LLC 41-038 WAILEA STREET C
Second Line	:
City	:	WAIMANALO
State	:	HI
Zip	:	96795
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	44-403 KANEOHE BAY DR
Second Line	:
City	:	KANEOHE
State	:	HI
Zip	:	96744-2611
Country	:	US
Telephone Number	:	808-429-4213
Fax Number	:

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

Provider Enumeration Date	:	11/07/2019
Last Update Date	:	11/28/2022

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