1053523977 NPI number — MRS. LAVERNE LANIUMA RIVAS LCSW BCD

Table of content: MRS. LAVERNE LANIUMA RIVAS LCSW BCD (NPI 1053523977)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053523977 NPI number — MRS. LAVERNE LANIUMA RIVAS LCSW BCD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RIVAS
Provider First Name:
LAVERNE
Provider Middle Name:
LANIUMA
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LCSW BCD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
TONG
Provider Other First Name:
LAVERNE
Provider Other Middle Name:
LANIUMA
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
LCSW BCD
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1053523977
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/20/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 968
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HALEIWA
Provider Business Mailing Address State Name:
HI
Provider Business Mailing Address Postal Code:
96712
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
808-722-0892
Provider Business Mailing Address Fax Number:
808-848-2069

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1485 LINAPUNI ST.
Provider Second Line Business Practice Location Address:
STE 105
Provider Business Practice Location Address City Name:
HONOLULU
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96819
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-722-0892
Provider Business Practice Location Address Fax Number:
808-848-2069
Provider Enumeration Date:
05/04/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  3336 , registered in the state of HI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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