Provider Demographics
NPI:1063645174
Name:FUNG, SAMANTHA SAU YU (CSAC, LCSW)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:SAU YU
Last Name:FUNG
Suffix:
Gender:F
Credentials:CSAC, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1315 KALAKAUA AVE APT 907
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96826-1943
Mailing Address - Country:US
Mailing Address - Phone:808-232-4768
Mailing Address - Fax:
Practice Address - Street 1:1315 KALAKAUA AVE APT 907
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96826-1943
Practice Address - Country:US
Practice Address - Phone:808-232-4768
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-24
Last Update Date:2015-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI1809-14101YA0400X
HILCSW-3958101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)