1568418135 NPI number — MS. DEBORAH A. WITHERS MSW, LICSW

Table of content: MS. DEBORAH A. WITHERS MSW, LICSW (NPI 1568418135)

General
Organization/Personal Information
Provider's Other Name Information
NPI Number Information
Provider's Business Mailing Address
Provider's Practice Location Mailing Address
Additional Information
Authorized Official
Provider Taxonomy Codes
Other Provider's Identifiers (legacy, non-NPI)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568418135 NPI number — MS. DEBORAH A. WITHERS MSW, LICSW

Organization/Personal Information

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:
WITHERS

Provider First Name:
DEBORAH

Provider Middle Name:
A.

Provider Name Prefix Text:
MS.

Provider Name Suffix Text:

Provider Credential Text:
MSW, LICSW

Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:

Provider Other Organization Name Type Code:

Provider Other Last Name:

Provider Other First Name:

Provider Other Middle Name:

Provider Other Name Prefix Text:

Provider Other Name Suffix Text:

Provider Other Credential Text:

Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1568418135

Entity Type Code:
Individual

Replacement NPI:

Last Update Date:
03/03/2023

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 685

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:
KAPAAU

Provider Business Mailing Address State Name:
HI

Provider Business Mailing Address Postal Code:
96755-0685

Provider Business Mailing Address Country Code:
US

Provider Business Mailing Address Telephone Number:
978-456-7705

Provider Business Mailing Address Fax Number:
978-456-7307

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
54-426 KAPAAU ROAD

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:
KAPAAU

Provider Business Practice Location Address State Name:
HI

Provider Business Practice Location Address Postal Code:
96755

Provider Business Practice Location Address Country Code:
US

Provider Business Practice Location Address Telephone Number:
978-456-7705

Provider Business Practice Location Address Fax Number:
808-209-8034

Provider Enumeration Date:
05/25/2006

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: 4272 , registered in the state of HI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Taxonomy code: 1041C0700X , with the licence number: 106953 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .