Provider Demographics
NPI:1225319437
Name:STRACK, ALISA JOY BISHOP (LCSW)
Entity Type:Individual
Prefix:
First Name:ALISA
Middle Name:JOY BISHOP
Last Name:STRACK
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 1:1 JARRETT WHITE RD.
Mailing Address - Street 2:TRIPLER 1 JARRET WHITE ROAD
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96819
Mailing Address - Country:US
Mailing Address - Phone:808-433-6606
Mailing Address - Fax:
Practice Address - Street 1:1 JARRET WHITE ROAD
Practice Address - Street 2:TRIPLER AMC
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96819
Practice Address - Country:US
Practice Address - Phone:808-433-6606
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-01
Last Update Date:2011-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI36741041C0700X, 2865M2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No2865M2000XHospitalsMilitary HospitalMilitary General Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIVAD000OtherUPIN
HIVAD000Medicare UPIN