Provider Demographics
NPI:1376085050
Name:TAKISHIMA-LACASA, JULIE YURIE (PHD)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:YURIE
Last Name:TAKISHIMA-LACASA
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:819 KAINOA PL
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96821-1737
Mailing Address - Country:US
Mailing Address - Phone:808-271-7748
Mailing Address - Fax:
Practice Address - Street 1:850 W HIND DR STE 202
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96821-1845
Practice Address - Country:US
Practice Address - Phone:808-427-2139
Practice Address - Fax:808-353-8010
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-10
Last Update Date:2020-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPSY1629103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI810235Medicaid
HI00B0374781OtherHMSA
HI13911190OtherHMAA
HIU073078OtherUHA
13911190OtherCAQH