Provider Demographics
NPI:1376416453
Name:LAKE, SABRINA MALOLOTO (LSW)
Entity type:Individual
Prefix:MRS
First Name:SABRINA
Middle Name:MALOLOTO
Last Name:LAKE
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 1:1345 S BERETANIA ST STE 301
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96814-1802
Mailing Address - Country:US
Mailing Address - Phone:808-533-3936
Mailing Address - Fax:
Practice Address - Street 1:197 SAND ISLAND ACCESS RD STE 201D
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96819-4901
Practice Address - Country:US
Practice Address - Phone:808-533-3936
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-09-25
Last Update Date:2025-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HILSW-3103101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health