Provider Demographics
NPI:1083861595
Name:MIRANDA-FUNTANILLA, ARLENE (QCSW, LSW)
Entity Type:Individual
Prefix:MRS
First Name:ARLENE
Middle Name:
Last Name:MIRANDA-FUNTANILLA
Suffix:
Gender:F
Credentials:QCSW, LSW
Other - Prefix:MISS
Other - First Name:ARLENE
Other - Middle Name:
Other - Last Name:MIRANDA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:QCSW
Mailing Address - Street 1:98-259 UALO ST
Mailing Address - Street 2:APT. P-2
Mailing Address - City:AIEA
Mailing Address - State:HI
Mailing Address - Zip Code:96701-4635
Mailing Address - Country:US
Mailing Address - Phone:808-386-2074
Mailing Address - Fax:
Practice Address - Street 1:98-259 UALO ST
Practice Address - Street 2:APT. P-2
Practice Address - City:AIEA
Practice Address - State:HI
Practice Address - Zip Code:96701-4635
Practice Address - Country:US
Practice Address - Phone:808-386-2074
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-26
Last Update Date:2008-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HILSW-615104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker