Provider Demographics
NPI:1912663170
Name:MAXERA, LEILANI ANN (LCSW)
Entity type:Individual
Prefix:
First Name:LEILANI
Middle Name:ANN
Last Name:MAXERA
Suffix:
Gender:
Credentials:LCSW
Other - Prefix:
Other - First Name:LANI
Other - Middle Name:ANN
Other - Last Name:RICCOBUONO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2265 PALOLO AVE APT B
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96816-3147
Mailing Address - Country:US
Mailing Address - Phone:808-353-8554
Mailing Address - Fax:
Practice Address - Street 1:908 S J ST
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-4110
Practice Address - Country:US
Practice Address - Phone:808-353-8554
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-11
Last Update Date:2025-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HILCSW-47011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical