Provider Demographics
NPI:1164749016
Name:WATANABE, DENISE LEONG (LCSW)
Entity Type:Individual
Prefix:
First Name:DENISE
Middle Name:LEONG
Last Name:WATANABE
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 1:949 KAMOKILA BLVD FL 3
Mailing Address - Street 2:
Mailing Address - City:KAPOLEI
Mailing Address - State:HI
Mailing Address - Zip Code:96707-2082
Mailing Address - Country:US
Mailing Address - Phone:808-675-7439
Mailing Address - Fax:
Practice Address - Street 1:949 KAMOKILA BLVD FL 3
Practice Address - Street 2:
Practice Address - City:KAPOLEI
Practice Address - State:HI
Practice Address - Zip Code:96707-2082
Practice Address - Country:US
Practice Address - Phone:808-675-7439
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-30
Last Update Date:2014-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HILCSW-30321041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical