Provider Demographics
NPI:1124660246
Name:LARIRIT, SHANA BETH (MSW, LCSW)
Entity type:Individual
Prefix:
First Name:SHANA
Middle Name:BETH
Last Name:LARIRIT
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:SHANA
Other - Middle Name:BETH
Other - Last Name:GEVINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW, LCSW
Mailing Address - Street 1:PO BOX 543
Mailing Address - Street 2:
Mailing Address - City:MAKAWAO
Mailing Address - State:HI
Mailing Address - Zip Code:96768-0543
Mailing Address - Country:US
Mailing Address - Phone:808-375-3000
Mailing Address - Fax:
Practice Address - Street 1:560 OLINDA RD
Practice Address - Street 2:
Practice Address - City:MAKAWAO
Practice Address - State:HI
Practice Address - Zip Code:96768-9102
Practice Address - Country:US
Practice Address - Phone:808-375-3000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-09
Last Update Date:2023-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI34941041C0700X
HILCSW-34941041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty