Provider Demographics
NPI:1336962323
Name:TATUPU-LEOPOLDO, BRYANNA FA (LCSW)
Entity type:Individual
Prefix:
First Name:BRYANNA
Middle Name:FA
Last Name:TATUPU-LEOPOLDO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1218 N SCHOOL ST APT 4C
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96817-2087
Mailing Address - Country:US
Mailing Address - Phone:808-392-0004
Mailing Address - Fax:
Practice Address - Street 1:1001 KAMOKILA BLVD STE 249
Practice Address - Street 2:
Practice Address - City:KAPOLEI
Practice Address - State:HI
Practice Address - Zip Code:96707-2091
Practice Address - Country:US
Practice Address - Phone:808-695-7700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-06
Last Update Date:2024-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI48331041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical