Provider Demographics
NPI:1285719963
Name:MAK-MIYAGI, ROSANA S (MSW, LSW)
Entity type:Individual
Prefix:MRS
First Name:ROSANA
Middle Name:S
Last Name:MAK-MIYAGI
Suffix:
Gender:F
Credentials:MSW, LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:459 PATTERSON ROAD
Mailing Address - Street 2:VAPIHCS
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96819-1710
Mailing Address - Country:US
Mailing Address - Phone:808-440-5309
Mailing Address - Fax:
Practice Address - Street 1:459 PATTERSON ROAD
Practice Address - Street 2:VAPIHCS
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96819-1710
Practice Address - Country:US
Practice Address - Phone:808-440-5309
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI223101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI223OtherSOCIAL WORK STATE LICENCE