Provider Demographics
NPI:1255474276
Name:LERER, BETH
Entity Type:Individual
Prefix:
First Name:BETH
Middle Name:
Last Name:LERER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 863
Mailing Address - Street 2:
Mailing Address - City:KEAAU
Mailing Address - State:HI
Mailing Address - Zip Code:96749-0863
Mailing Address - Country:US
Mailing Address - Phone:808-965-2243
Mailing Address - Fax:808-965-2245
Practice Address - Street 1:15-2866 GOVERNMENT MAIN ROAD
Practice Address - Street 2:BLDG. E
Practice Address - City:PAHOA
Practice Address - State:HI
Practice Address - Zip Code:96778
Practice Address - Country:US
Practice Address - Phone:808-965-2243
Practice Address - Fax:808-965-2245
Is Sole Proprietor?:No
Enumeration Date:2007-02-15
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI539372-17Medicaid