Provider Demographics
NPI:1720100365
Name:VILLANTI, MICHELLE (LCSW)
Entity type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:
Last Name:VILLANTI
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 1:1135 MAKAWAO AVE PMB 340
Mailing Address - Street 2:
Mailing Address - City:MAKAWAO
Mailing Address - State:HI
Mailing Address - Zip Code:96768-7403
Mailing Address - Country:US
Mailing Address - Phone:808-870-9886
Mailing Address - Fax:
Practice Address - Street 1:1152 MAKAWAO AVE
Practice Address - Street 2:
Practice Address - City:MAKAWAO
Practice Address - State:HI
Practice Address - Zip Code:96768-9448
Practice Address - Country:US
Practice Address - Phone:808-870-9886
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-04
Last Update Date:2009-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HILCSW30281041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI0000227835OtherHMSA
HI00A0227833OtherHMSA
HI0000227835OtherHMSA