Provider Demographics
NPI:1396176798
Name:NAKAMOTO, LEE ANN OS (LCSW)
Entity type:Individual
Prefix:MRS
First Name:LEE ANN
Middle Name:OS
Last Name:NAKAMOTO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MISS
Other - First Name:LEE ANN
Other - Middle Name:OKIDO
Other - Last Name:SHIMABUKU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:98-222 PUAALII ST
Mailing Address - Street 2:
Mailing Address - City:AIEA
Mailing Address - State:HI
Mailing Address - Zip Code:96701
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:98-1256 KAAHUMANU ST # E301
Practice Address - Street 2:
Practice Address - City:PEARL CITY
Practice Address - State:HI
Practice Address - Zip Code:96782-3282
Practice Address - Country:US
Practice Address - Phone:808-484-4489
Practice Address - Fax:808-484-4494
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-10
Last Update Date:2016-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI38991041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical