Provider Demographics
NPI:1114277282
Name:NISHIZAKI, LAURA CATHERINE MOA (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:CATHERINE MOA
Last Name:NISHIZAKI
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:KAUIONALANI
Other - Middle Name:CATHERINE
Other - Last Name:NISHIZAKI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:91-1493 LOILOI LOOP
Mailing Address - Street 2:
Mailing Address - City:EWA BEACH
Mailing Address - State:HI
Mailing Address - Zip Code:96706-4875
Mailing Address - Country:US
Mailing Address - Phone:808-391-2524
Mailing Address - Fax:
Practice Address - Street 1:1301 PUNCHBOWL ST
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813-2402
Practice Address - Country:US
Practice Address - Phone:808-691-7336
Practice Address - Fax:808-691-4305
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-14
Last Update Date:2022-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HILSW2118104100000X
HILCSW46451041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker