Provider Demographics
NPI:1033544044
Name:COCCETTI, MARY A (LCSW)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:A
Last Name:COCCETTI
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 1:2430 S KIHEI RD
Mailing Address - Street 2:APT 602
Mailing Address - City:KIHEI
Mailing Address - State:HI
Mailing Address - Zip Code:96753-9672
Mailing Address - Country:US
Mailing Address - Phone:808-879-4191
Mailing Address - Fax:
Practice Address - Street 1:411 HUKU LII PL
Practice Address - Street 2:302
Practice Address - City:KIHEI
Practice Address - State:HI
Practice Address - Zip Code:96753-7062
Practice Address - Country:US
Practice Address - Phone:808-891-1411
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-09
Last Update Date:2021-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI33481041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI25903OtherHMSA PROVIDER #