Provider Demographics
NPI:1225203631
Name:NATIVIDAD, MARY-ELIZABETH (LSW)
Entity Type:Individual
Prefix:
First Name:MARY-ELIZABETH
Middle Name:
Last Name:NATIVIDAD
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:98-150 KAONOHI ST
Mailing Address - Street 2:
Mailing Address - City:AIEA
Mailing Address - State:HI
Mailing Address - Zip Code:96701-5047
Mailing Address - Country:US
Mailing Address - Phone:808-539-2273
Mailing Address - Fax:808-528-1711
Practice Address - Street 1:98-150 KAONOHI ST STE B219
Practice Address - Street 2:
Practice Address - City:AIEA
Practice Address - State:HI
Practice Address - Zip Code:96701-5022
Practice Address - Country:US
Practice Address - Phone:808-539-2273
Practice Address - Fax:808-528-1711
Is Sole Proprietor?:No
Enumeration Date:2008-04-25
Last Update Date:2023-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HILSW-3099104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker