Provider Demographics
NPI:1043354137
Name:HAYWARD, JULIE C (LCSW)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:C
Last Name:HAYWARD
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 1:4370 KUKUI GROVE STREET
Mailing Address - Street 2:SUITE 3-211
Mailing Address - City:LIHU
Mailing Address - State:HI
Mailing Address - Zip Code:96766
Mailing Address - Country:US
Mailing Address - Phone:541-673-0057
Mailing Address - Fax:541-673-2270
Practice Address - Street 1:4370 KUKUI GROVE STREET
Practice Address - Street 2:SUITE 3-211
Practice Address - City:LIHUE
Practice Address - State:HI
Practice Address - Zip Code:96766
Practice Address - Country:US
Practice Address - Phone:541-673-0057
Practice Address - Fax:541-673-2270
Is Sole Proprietor?:No
Enumeration Date:2007-02-20
Last Update Date:2015-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORL28841041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR117801Medicare ID - Type UnspecifiedPROVDER NUMBER