Provider Demographics
NPI:1053063230
Name:SEMBRANO, MELODY ANTOINETTE SIMPLICIANO
Entity Type:Individual
Prefix:MRS
First Name:MELODY ANTOINETTE
Middle Name:SIMPLICIANO
Last Name:SEMBRANO
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:MELODY ANTOINETTE
Other - Middle Name:CABILES
Other - Last Name:SIMPLICIANO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1882 KEEAUMOKU STREET
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96822-5850
Mailing Address - Country:US
Mailing Address - Phone:808-521-4357
Mailing Address - Fax:
Practice Address - Street 1:1822 KEEAUMOKU ST
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96822-3001
Practice Address - Country:US
Practice Address - Phone:808-521-4357
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-19
Last Update Date:2022-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIH01090408104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker