Provider Demographics
NPI:1063238350
Name:MARTIN, JULIE (LSW)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:
Last Name:MARTIN
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2648 E MANOA RD
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96822-1845
Mailing Address - Country:US
Mailing Address - Phone:810-956-3355
Mailing Address - Fax:
Practice Address - Street 1:1188 BISHOP ST STE 1007
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813-3304
Practice Address - Country:US
Practice Address - Phone:808-913-8840
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-02
Last Update Date:2024-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HILSW-3311104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker