Provider Demographics
NPI:1417217126
Name:HEATHER JABLONSKI, LCSW LLC
Entity type:Organization
Organization Name:HEATHER JABLONSKI, LCSW LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:
Authorized Official - Last Name:JABLONSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:808-397-0752
Mailing Address - Street 1:95-270 WAIKALANI DR, C-302
Mailing Address - Street 2:
Mailing Address - City:MILILANI
Mailing Address - State:HI
Mailing Address - Zip Code:96789-3544
Mailing Address - Country:US
Mailing Address - Phone:808-397-0752
Mailing Address - Fax:
Practice Address - Street 1:66-250 KAMEHAMEHA HWY STE D204
Practice Address - Street 2:
Practice Address - City:HALEIWA
Practice Address - State:HI
Practice Address - Zip Code:96712-1470
Practice Address - Country:US
Practice Address - Phone:808-397-0752
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-29
Last Update Date:2017-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HILCSW-31781041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty