MEDICARE: MRS. DONECIA RENEE LITALIEN LSW

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	LSW-1543	HI

General Provider Information

NPI Number	:	1750668240
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. DONECIA RENEE LITALIEN LSW

Provider Business Mailing Address
First Line	:	2264 WAIKAHE CT
Second Line	:
City	:	PEARL CITY
State	:	HI
Zip	:	96782-3478
Country	:	US
Telephone Number	:	808-220-5726
Fax Number	:

Provider Business Practice Location Address
First Line	:	2264 WAIKAHE CT
Second Line	:
City	:	PEARL CITY
State	:	HI
Zip	:	96782-3478
Country	:	US
Telephone Number	:	808-220-5726
Fax Number	:

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

Provider Enumeration Date	:	11/10/2011
Last Update Date	:	11/10/2011

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