Provider Demographics
NPI:1205026614
Name:BIRDSALL, MICHELLE MK (MSW, LCSW)
Entity Type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:MK
Last Name:BIRDSALL
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:MS
Other - First Name:MICHELLE
Other - Middle Name:M
Other - Last Name:KAYA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:91-110 HANUA ST
Mailing Address - Street 2:208A
Mailing Address - City:KAPOLEI
Mailing Address - State:HI
Mailing Address - Zip Code:96707-1705
Mailing Address - Country:US
Mailing Address - Phone:808-383-3764
Mailing Address - Fax:888-610-7695
Practice Address - Street 1:91-110 HANUA ST
Practice Address - Street 2:208A
Practice Address - City:KAPOLEI
Practice Address - State:HI
Practice Address - Zip Code:96707-1705
Practice Address - Country:US
Practice Address - Phone:808-383-3764
Practice Address - Fax:888-610-7695
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-01
Last Update Date:2022-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HILCSW 31911041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical