Provider Demographics
NPI:1396108791
Name:EXPANDING HORIZONS HAWAII
Entity type:Organization
Organization Name:EXPANDING HORIZONS HAWAII
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL SOCIAL WORKER
Authorized Official - Prefix:
Authorized Official - First Name:WENDY
Authorized Official - Middle Name:
Authorized Official - Last Name:SIMONETTI
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:808-222-8057
Mailing Address - Street 1:1617 MILLER ST APT 7
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96813-1898
Mailing Address - Country:US
Mailing Address - Phone:808-222-8057
Mailing Address - Fax:
Practice Address - Street 1:45-955 KAMEHAMEHA HWY STE 206
Practice Address - Street 2:
Practice Address - City:KANEOHE
Practice Address - State:HI
Practice Address - Zip Code:96744-3293
Practice Address - Country:US
Practice Address - Phone:808-222-8057
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-01
Last Update Date:2016-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HILCSW-35751041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI000293910OtherHMSA